Therapeutic plasma exchange of neuroimmune disorders

We present a single-center experience of therapeutic plasma exchange (TPE) for various neuroimmune disorders. TPE is an established option for therapy-refractory multiple sclerosis (MS), myasthenia gravis (MG), and neuromyelitis optica spectrum disorders (NMOSD). Patients present with symptoms ranging from minor visual impairment and muscle weakness to blindness and complete paralysis. Although currently available therapies are extensive, chronic symptoms remain a major burden.

We performed a systematic retrospective data analysis of patients with neuroimmune disorders who received TPE between January 2017 and April 2024 at our department. Our study includes 33 patients (MS n=21, MG n=6, NMOSD n=6) who were admitted for TPE due to unresponsive major flare to current medication and/or high dose corticosteroid therapy. Medical history, clinical symptoms, relevant past and current medication, number of TPE sessions, and clinical outcome parameters have been analyzed to assess the significance of TPE as an escalation therapy at a major academic center.

The time between diagnosis and first TPE was 3.5 (mean; ±1.7 SD) years. The most common symptoms were vision impairment (85 %), paralysis (61 %), dysesthesia (56 %) and pain (28 %). The average number of flare ups per year was 0.8 (±1.6 SD). The average number of TPE sessions per year and patient was 2.3 (±4.1 SD), respectively. Forty-eight percent of patients have received two or more approved medications besides corticosteroids before TPE. Seventy-two percent of patients achieved an alleviation of symptoms after TPE. Regarding the current clinical status, sixty-one percent of patients can be classified with a stable disease, whereas thirty percent are still facing aggravating symptoms unresponsive to current therapy.

We observed that a significant proportion of patients referred to TPE is clinically progressive and may benefit from therapy escalation and TPE maintenance. A novel approach is anti-CD19 chimeric antigen receptor (CAR) T-cell therapies, which is currently examined in clinical trials for treatment of autoimmune disorders, including patients with chronic neuroimmune diseases. The results of these studies are eagerly awaited.

I declare that I have no potential conflicts of interest to disclose that relate to the research described.