Clinical Efficacy of Plasma-Exchange in Patients with Progressive forms of Multiple Sclerosis and NMO-Spectrum Disease

Background: Plasma-exchange/plasmapheresis (PLEX) is an efficient treatment for several immune mediated diseases. In addition to its known efficacy in myasthenia gravis and Gulliain Barre syndrome, it has been also shown to be effective in certain patients with MS and other CNS demyelinating disorders, during an acute/sub-acute deterioration of the disease. Aims and methods: We report the results of an open prospective study with PLEX in 36 patients with progressive forms of multiple sclerosis (either secondary progressive or relapsing-progressive) and 12 patients with NMO-spectrum disease. All patients had experienced a significant clinical deterioration in the year prior to inclusion (0.5-1 degree or more, in the EDSS scale or a severe relapse from which they did not fully recover) and responded partially or not at all to steroidal treatment. The mean EDSS score at inclusion was 5.91 ± 1.46. The mean EDSS for the MS subgroup was 5.95 ± 1.3 and for the NMO subgroup, 5.6 ± 1.4. The mean duration of the disease was 11.4 ± 7.8 years (12 ± 7.6 for the MS and 5.75 4.59 for the NMO). All patients were treated with 5 courses of PLEX in 2 weeks, followed by a monthly course for one year. Results: Twenty eight of the 48 patients (58.3 %) improved significantly in the EDSS score at year one post initiation of PLEX. The mean EDSS score declined from 5.91 ± 1.46 at inclusion, to 5.41 ± 1.8 at year one. This improvement was more pronounced in the NMO group: Ten out of twelve patients with NMO (83%) improved and their mean EDSS score was reduced from 5.6 ± 1.4 before the treatment to 4.7 ± 1.5 EDSS score post PLEX. In the whole group there were 16 patients with over imposed relapses (relapsing-progressive course) with a total of 26 relapses in the year prior to the inclusion; the number of relapses during the year following PLEX was reduced from 26 to 4. In general patients with prominent myelitic involvement had the most impressive response to the treatment. Five patients suffered from minor infections and one was admitted with sepsis. No other major side effects were observed. Conclusion: PLEX may benefit some patients with progressive MS and NMO and thus may represent an alternative second line treatment modality for such patients with highly active disease, especially those with myelitic forms, and recent deterioration that did not respond to steroids. Larger, controlled studies are warranted to confirm the efficacy of PLEX in these subgroups of MS.