title: Benefit in long-term response and mortality of treatment with intravenous immunoglobulin prior to plasmapheresis in peripheral polyneuropathies.
abstract: OBJECTIVE
  The benefits of plasmapheresis (PA) for neurologic autoimmune diseases have been widely demonstrated. Little is known about the long-term neurologic prognosis and course after PA and immunosuppressive (IS) and/or intravenous immunoglobulin (IVIG) treatment. We aimed to analyse features associated with short-term response and long-term outcome and prognosis (neurologic status and mortality) of peripheral polyneuropathy (PP) and central nervous system acute inflammatory disease (CNSAID) treated with PA.
  
  
  METHODS
  A descriptive, retrospective single-centre study from January 2005 to December 2012.
  
  
  RESULTS
  There were 26 episodes, which included 16 CNSAID and 10 PP cases. First line therapy included PA (n=4), IS drugs (n=15), and IVIG (n=7). Responses were achieved in 80% and 50% of PP and CNSAID cases, respectively. For PP, first line treatment with IVIG and no IS treatment prior to or during PA were variables associated with short-term response (P=0.067), good or stable neurologic status at the end of follow-up (P=0.008), and lower mortality rate (P=0.008). For CNSAID, initial EDSS score≥7 (P=0.019) was related to long-term good or stable neurologic status. During the study period, 177 sessions were conducted; 3.4% had technical complications and 8.5% clinical complications. However, these incidents were all minor and no PA session had to be discontinued.
  
  
  CONCLUSIONS
  The response rates achieved in our patients were similar to those of other research. PA has a safe profile but double-blind, controlled studies are needed to evaluate the synergy of sequential treatment with IGIV followed by PA and the possible benefit for long-term outcome.
authors.affiliation: Department of Hematology and Haemotherapy, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain. Electronic address: ingrid.mps@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Parra-Salinas
authors.affiliation: Department of Hematology and Haemotherapy, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
authors.forename: V P
authors.initials: VP
authors.lastname: González-Rodríguez
authors.affiliation: Department of Hematology and Haemotherapy, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Gracia Pina
authors.affiliation: Department of Hematology and Haemotherapy, Miguel Servet University Hospital, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: Gimeno Lozano
authors.affiliation: Department of Haematology and Haemotherapy, San Jorge Hospital, Av. Martínez de Velasco, 36, 22004 Huesca, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: García-Erce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002493:Central Nervous System Diseases / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011115:Polyneuropathies / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: Aphérèse plasmatique; Devic syndrome; Guillain-Barré syndrome; Immunoglobuline intraveineuse; Maladie de Devic; Multiple sclerosis; Plasmapheresis; Sclérose multiple; Syndrome de Guillain-Barré