Fleni
Neurology

Author Of 1 Presentation

Disease Modifying Therapies – Mechanism of Action Poster Presentation

P0408 - Therapeutic Plasma Exchange in MS relapses: long term outcome (ID 1415)

Speakers
Presentation Number
P0408
Presentation Topic
Disease Modifying Therapies – Mechanism of Action

Abstract

Background

High-dose short-term intravenous methylprednisolone (IVMP) is the standard treatment for Multiple Sclerosis (MS) relapses. However, 25% of patients do not respond and remain with significant disability. In these patients, therapeutic plasma exchange (TPE) has proven effective, although evidence of long-term efficacy after use of this procedure is lacking.

Objectives

The aims of this study were to: 1) compare outcomes of patients treated with or without TPE at 12, 18 and 24 months, and 2) evaluate features associated with better response to TPE.

Methods

We performed a retrospective cohort study of all relapse remitting MS patients (RRMSp) treated with IVMP and TPE between January 2011 and January 2018 and compared them to a second group of RRMSp, matched for age, sex, disease duration and disability level at time of relapse, treated only with IVMPS. Number of relapses were recorded. Good response to treatment was defined as at least 50% reduction in EDSS score. Results were reported as median and interquartile range for numerical variables, and as percentage of the total number of patients, for categorical variables. P values below 0.05 were considered significant.

Results

Twenty-four patients (66% female, age: 39± 11 years) treated with TPE, and 43 patients treated with IVMP alone (70% female, age: 39± 6 years) were included. TPE-treated patients had experienced more relapses in the 2-years prior to the study (3±2 vs 2±1, p=0,03). Time from symptom onset to treatment with IVMP or duration of IVMP treatment was similar in both groups (5 ± 9 days vs 7± 11 days, p=0.1). After the relapse, TPE-treated patients were escalated to a high efficacy disease modifying therapy more frequently during follow up than the comparator group (25% vs 16%, p=0,02).

Although initial EDSS scores were similar in both groups, no differences were found in EDSS or Kurtzke functional systems scores at 12, 18 and 24-months follow-up (TPE 1 (0-2) vs IVMP 1 (0-2)).

65% of RRMSp treated with TPE had a good response to treatment. No significant association was found between positive response and initial relapse severity, distribution or number of gadolinium-enhancing lesions, or time to TPE.

Conclusions

No differences in functional outcomes were found in MS relapses treated with or without TPE after 24 months follow up; nor were any predictors of favorable response to treatment with TPE in this preliminary analysis.

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