Therapeutic Effect of Plasma Exchange in Steroid Refractory Inflammatory Demyelination of Central Nervous System: Outcome from a Tertiary Centre in Malaysia

Objective: To evaluate the efficacy of plasma exchange (PLEX) in steroid refractory inflammatory demyelination diseases (IDD) of Central nervous system (CNS). Methods: Retrospective review of patients presented with steroid refractory IDD from 2006 to 2016 that underwent PLEX. Clinical data on neurological assessment, time to treatment initiation, visual acuity (VA) and Expanded Disability Status Scale (EDSS) were gathered from the medical records. The primary outcome was improvement at 3 months after PLEX. Statistical analysis was done using the SPSS version 21. Results: Forty-three plasma exchanges were performed involving 27 patients (NMOSD= 22, RRMS= 4, ITM= 1). The mean age of patient was 43.60 ± 15.18, and the mean EDSS was 7.98 ± 1.07 at presentation. The anti-AQP4 antibody was detected in 81.5%. Treatment success was observed in 21/43 (48.8%) of patients with a significant improvement of 2.13 EDSS point post PLEX. A lower baseline EDSS score ≤ 6 showed a trend toward good outcome (p= 0.07). AQP4 status had no influence on treatment outcome. Male gender, preserved reflexes, use of DMT and shorter time to PLEX initiation, were not associated with treatment outcome. Conclusion: PLEX is an effective treatment for steroid refractory IDD, regardless of the AQP4 antibody status. A lower baseline EDSS might be associated with a better treatment outcome. PLEX should be considered irrespective of the symptom duration.