Therapeutic Plasma Exchange as a Treatment for Autoimmune Neurological Disease. 2020

Ivana Nieto-Aristizábal, and Álvaro J Vivas, and Pablo Ruiz-Montaño, and Cristian C Aragón, and Iván Posso-Osorio, and Jairo Quiñones, and Julián Alejandro Rivillas, and Gabriel J Tobón
GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Universidad Icesi and Fundación Valle del Lili, Cra. 98 18-49, Cali, Colombia.

BACKGROUND Therapeutic plasma exchange (TPE) is commonly used as treatment of certain autoimmune neurological diseases (ANDs), and its main objective is the removal of pathogenic autoantibodies. Our aim was to describe the clinical profile and the experience with the usage of TPE in patients with ANDs at our institution. METHODS This is an observational retrospective study, including medical records of patients with diagnosis of ANDs who received TPE, between 2011 and 2018. Characteristics of TPE, such as number of cycles, type of replacement solution, and adverse effects, were evaluated. The modified Rankin Scale (mRS) was applied to measure the clinical response after the therapy. RESULTS 187 patients were included with the following diagnoses: myasthenia gravis (MG), n = 70 (37%); Guillain-Barré syndrome (GBS), n = 53 (28.3%), neuromyelitis optica spectrum disorders (NMOSD), n = 35 (18.7%); chronic inflammatory demyelinating polyneuropathy (CIDP), n = 23 (12.2%); and autoimmune encephalitis (AE), n = 6 (3.2%). The most used types of replacement solution were albumin (n = 131, 70%) and succinylated gelatin (n = 45, 24%). All patients received a median of five cycles (IQR 5-5). Hypotension and hydroelectrolytic disorders were the main complications. After TPE, 99 patients (52.9%) showed improvement in the mRS scores and a statistical significance (p < 0.05) was seen between the admission score and after TPE for every diagnosis except for CIDP. CONCLUSIONS TPE has an adequate safety profile, and improvement in functionality in treated patients reflects its effectiveness.

UI MeSH Term Description Entries

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