Apheresis therapies in MOGAD: a retrospective study of 117 therapeutic interventions in 571 attacks
Journal: Journal of Neurology, Neurosurgery & Psychiatry; November 4, 2024
Author(s): Carolin Schwake, Theodoros Ladopoulos, Vivien Häußler, Ingo Kleiter, Marius Ringelstein, Orhan Aktas, Tania Kümpfel, Daniel Engels, Joachim Havla, Martin W Hümmert, Julian Reza Kretschmer, Daria Tkachenko, Corinna Trebst, Ana Beatriz Ayroza Galvão Ribeiro Gomes, Anne-Katrin Pröbstel, Mirjam Korporal-Kuhnke, Brigitte Wildemann, Sven Jarius, Refik Pul, Mosche Pompsch, Markus Krämer, Florian Then Bergh, Clemens Gödel, Patricia Schwarz, Markus C Kowarik, Paulus Stefan Rommer, Ioannis Vardakas, Makbule Senel, Alexander Winkelmann, Nele Retzlaff, Martin S Weber, Leila Husseini, Annette Walter, Patrick Schindler, Judith Bellmann-Strobl, Friedemann Paul, Ralf Gold, Ilya Ayzenberg, Neuromyelitis Optica Study Group (NEMOS)
How effective are blood-filtering treatments like plasma exchange for MOGAD?
The goal of MOGAD treatment during an active relapse is to stop inflammation as quickly as possible, to avoid long-term disability. Apart from treatments with high-dose steroids, doctors may use a blood-filtering treatment called apheresis, which removes harmful antibodies and inflammatory substances from the blood. There are two main types of apheresis: plasma exchange and immunoadsorption.
This study looked at the outcomes of 117 MOGAD attacks in 85 patients treated with apheresis across 18 specialist centers in Germany, Austria, and Switzerland to understand how effective apheresis treatments are for curbing MOGAD attacks.
Apheresis was used most often in attacks that affected both the optic nerve and spinal cord at the same time, and less often for attacks affecting only the spinal cord, brain, or optic nerve.
Most patients received apheresis after steroids had not worked well enough; 62% received it after one course of steroids and 26% after two courses of steroids. Only 12% of patients received it as the first treatment for their attack.
After treatment, 21% of people recovered completely, 70% recovered partially, and 9% did not improve. Apheresis was most effective if started within 2 days from the beginning of symptoms.
People who received apheresis earlier after their symptoms began and those who were already on a disease-modifying immunosuppressive therapy when apheresis was given were more likely to make a full recovery with less long-term disability. Similar results were seen for both plasma exchange and immunoadsorption.
Related article: Efficacy and safety of apheresis therapy in AQP4 antibody-positive NMOSD attack: A propensity score-matched cohort study
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