Abstract
Introduction 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. Conclusion TPE has an adequate safety profile, and improvement in functionality in treated patients reflects its effectiveness.
Highlights
Introduction. erapeutic plasma exchange (TPE) is commonly used as treatment of certain autoimmune neurological diseases (ANDs), and its main objective is the removal of pathogenic autoantibodies
187 patients were included with the following diagnoses: myasthenia gravis (MG), n = 70 (37%); Guillain–Barresyndrome (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%). e most used types of replacement solution were albumin (n = 131, 70%) and succinylated gelatin (n = 45, 24%)
TPE involves plasma removal and replacement with a solution such as a colloid solution or a combination of a crystalloid/colloid solution [1]. Even though it was initially conceived as a treatment for hematological diseases with presumed or demonstrated immune pathophysiology [2], treatment using TPE has been extended to a variety of pathologies including kidney, autoimmune rheumatological, and neurological diseases, with the latter being the pathology most frequently treated by TPE [3]. e increased usage of TPE has likely followed an increased understanding of its mechanisms of action, which range from the removal of pathogenic autoantibodies and immune complexes to improvement in monocyte function [2]
Summary
Is is an observational retrospective study, including medical records of patients with diagnosis of ANDs who received TPE, between 2011 and 2018. The number of treatment cycles, type of replacement solution, clinical characteristics as duration of inpatient stay, adverse effects, and death of patients were evaluated. Since most of the evaluated diagnoses (e.g., MG, GBS, and CIDP) have a disease-specific scale, we used the modified Rankin Scale (mRS) to measure and compare the clinical improvement between our patients. Us, the mRS was applied to every patient at three different times: at admission, using the admission note of the department of neurology; after TPE, using their progress note registered after completing all the cycles; and 90-days after receiving TPE, using medical records of follow-up appointments with neurologists. Quantitative variables are shown with frequencies and proportions. mRS scores are presented as medians with IQRs; scores at admission and after TPE were compared with the Wilcoxon matched-pair signed-rank test
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