Early clinical response and complications of therapeutic plasma exchange in central nervous system demyelinating diseases.

IF 2.6 Q2 CLINICAL NEUROLOGY
Journal of Central Nervous System Disease Pub Date : 2024-06-19 eCollection Date: 2024-01-01 DOI:10.1177/11795735241262738
Mehran Rashidi, Saba Naghavi, Neda Ramezani, Fereshteh Ashtari, Vahid Shaygannejad, Sayed Mohsen Hosseini, Iman Adibi
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引用次数: 0

Abstract

Background: Appropriate treatment reduces the severity and duration of relapses in demyelinating diseases of Central Nervous System (CNS). If high-dose corticosteroids treatment fails, therapeutic plasma exchange (TPE) is considered as a rescue treatment.

Objectives: This study aimed to investigate early clinical response and complications of TPE and prognostic factors in CNS demyelinating relapses.

Design: This prospective observational study was designed in a tertiary center during one year.

Methods: All adult patients diagnosed corticosteroid-resistant Multiple Sclerosis (MS), NeuroMyelitis Optica Spectrum Disorder (NMOSD), idiotypic Transverse Myelitis or Clinical Isolated Syndrome relapses, were eligible. Clinical response is defined based on Expanded Disability Status Scale (EDSS) at discharge. Clinical and laboratory complications recorded.

Results: Seventy-two patients were analyzed which 58.3% patients were female. MS was diagnosed for 61.1% of cases. Thirty-five patients (48.6%) responded and the mean differences of EDSS significantly decreased 0.60 score (CI95%:0.44-.77). Electrolyte imbalances and thrombocytopenia occurred in 80.6% and 55.6% of cases respectively and 40.3% of patients had systemic reactions. However, 26.4% patients experienced moderate to severe complications. In patients with moderate to severe disability, responders were younger (MD: 8.42 years, CI95%: 1.67-15.17) and had lower EDSS score at admission (median:6, IQR: 5.5-6 against 7.5 IQR: 6.5-8). The risk of failure was higher in active progressive MS patients compared with RRMS patients (OR: 6.06, CI 95%:1.37-26.76). Patients with thrombocytopenia were hospitalized more than others (MD: 1.5 days, CI 95%: 0-3). Females were more prone to hypokalemia and systemic reactions (OR: 3.11, CI 95%:1.17-8.24 and OR: 6.67, CI 95%:2.14-20.81 respectively).

Conclusion: The most common indication of TPE was corticosteroid-resistant severe MS relapses. About half of the patients presented an early clinical response. Lower disability, younger age and RRMS diagnosis are prognostic factors of better response. One out of four patients experienced moderate to severe complications, mainly electrolyte imbalances and systemic reactions. Appropriate interventions against these complications should be considered during TPE, especially in females.

中枢神经系统脱髓鞘疾病治疗性血浆置换的早期临床反应和并发症。
背景:适当的治疗可减轻中枢神经系统(CNS)脱髓鞘疾病复发的严重程度和持续时间。如果大剂量皮质类固醇治疗失败,治疗性血浆置换(TPE)被认为是一种挽救性治疗方法:本研究旨在调查中枢神经系统脱髓鞘性疾病复发时治疗性血浆置换术的早期临床反应、并发症和预后因素:这项前瞻性观察研究在一家三级医疗中心进行,为期一年:所有确诊为皮质类固醇耐药多发性硬化症(MS)、神经性脊髓炎(NMOSD)、特异性横贯性脊髓炎或临床孤立综合征复发的成年患者均符合条件。临床反应是根据出院时的残疾状况扩展量表(EDSS)定义的。记录临床和实验室并发症:72名患者接受了分析,其中58.3%为女性。61.1%的病例确诊为多发性硬化症。35名患者(48.6%)做出了反应,EDSS平均值显著下降了0.60分(CI95%:0.44-0.77)。分别有 80.6% 和 55.6% 的患者出现电解质失衡和血小板减少,40.3% 的患者出现全身反应。然而,26.4%的患者出现了中度至重度并发症。在中度至重度残疾患者中,应答者更年轻(MD:8.42 岁,CI95%:1.67-15.17),入院时的 EDSS 评分更低(中位数:6,IQR:5.5-6 对 7.5,IQR:6.5-8)。与 RRMS 患者相比,活动性进行性多发性硬化症患者的治疗失败风险更高(OR:6.06,CI 95%:1.37-26.76)。血小板减少症患者的住院天数高于其他患者(MD:1.5 天,CI 95%:0-3 天)。女性更容易出现低钾血症和全身反应(OR:3.11,CI 95%:1.17-8.24 和 OR:6.67,CI 95%:2.14-20.81):TPE最常见的适应症是皮质类固醇耐药的严重多发性硬化症复发。结论:TPE最常见的适应症是皮质类固醇耐药的严重多发性硬化症复发,约半数患者出现早期临床反应。较低的残疾程度、较年轻的年龄和 RRMS 诊断是较好反应的预后因素。四名患者中有一名出现了中度至重度并发症,主要是电解质失衡和全身反应。在进行TPE治疗时,应考虑对这些并发症采取适当的干预措施,尤其是女性患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
0.00%
发文量
39
审稿时长
8 weeks
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