Therapeutic Apheresis for Neurological Diseases: A Five-Year Retrospective Study at a Large Academic Medical Center

Abstract

Therapeutic plasma exchange (TPE) represents a crucial treatment modality for a wide range of neurological disorders. However, data regarding institutional variation in practice and clinical trends over time is limited, especially concerning diagnostic indications, treatment setting, line access, safety, and the impact of novel drug therapies on TPE utilization. We analyzed all TPE procedures performed at our institution between 2019 and 2023 for neurological indications. A total of 109 patients and 1310 procedures were retrospectively reviewed, focusing on procedure volumes, clinical parameters, and safety outcomes. An average of 173 procedures were performed per year, with no significant change in volume year-to-year. However, a significant decrease in the proportion of TPE procedures performed for myasthenia gravis (MG) was found over time. The most common diagnoses included MG, demyelinating diseases, and encephalitis. The overall complication rate was found to be 3.4%, most commonly hypotension and perioral tingling. While most procedures were conducted in the outpatient setting, we found a significant increase in the proportion of inpatient procedures over time. Additionally, most TPE procedures were conducted via central line, and we observed a significant increase in central line use over time. Notably, three MG patients safely received greater than 90 procedures each during the study period, with significantly fewer complications than the general cohort. These findings provide valuable insights into TPE management of neurological disorders, reaffirming its safety even in chronic refractory disease, and highlighting key trends relevant to treatment setting, line access, and the impact of novel drug therapies.