Plasma Exchange in Secondary Progressive Multiple Sclerosis: Twenty-Five Year Follow-Up Study

Abstract

Secondary Progressive multiple sclerosis (SPMS) is a common form of MS with few approved and effective therapies. Previous studies of therapeutic plasma exchange (PLEX) in SPMS have reported mixed results. The purpose of this study was to evaluate long-term efficacy and safety of PLEX in SPMS. We retrospectively analyzed 25 years of PLEX therapy in SPMS to identify improvements in disease progression and disability as well as potential predictors of therapeutic success. Using 271 patients, we show a significant improvement in Expanded Disability Status Scale (EDSS) lasting for at least three years following a course of PLEX. Furthermore, disability remained significantly improved or stabilized for seven years post-PLEX. Patients with continued and measureable disability worsening in the previous three years are more apt to improve with PLEX. A small number of patients (N=42) for whom PLEX was considered but denied by their insurance carriers, and who therefore received other treatments, were also followed over the 25 year period. Progression of disability in this group was significantly worse when compared with PLEX group. No major problems occurred during 8709 PLEX procedures. Peripheral vascular access (venous or arterial) was utilized to avoid complications related to central line placement. Because of the paucity of beneficial therapeutic interventions in SPMS and the relative safety and efficacy of long-term PLEX, this therapy should be considered in this form of MS.