Immunoadsorption with Regenerating Columns in Treatment of Steroid-Refractory Relapse in Multiple Sclerosis and Optic Neuritis

Abstract Objective: Immunoadsorption (IA) is increasingly recognized as a promising and low-risk therapy option in a variety of autoimmune neurologic disorders. Along with plasma exchange (PE) it is considered as a second line therapy in multiple sclerosis (MS) and optic neuritis (ON) and usually regarded as a therapy option in case of steroid-refractory relapse in most guidelines. However, systematic prospective data is missing, especially regarding modern efficient adsorber systems with regenerating columns. The aim of this study was to provide efficacy and tolerability data in patients with steroid-refractory multiple sclerosis and optic neuritis. Methods: We prospectively investigated the clinical course of 25 patients with steroid-refractory relapse of MS or ON who were treated with IA using regenerating protein A columns. IA was performed on 5 consecutive days, and 2- to 2.5-fold plasma volumes were processed each day. As objective outcome parameters, Expanded Disability Status Scale (EDSS) and visual acuity measurement were conducted before as well as on day 5 of IA and 14 days after treatment. Additionally, adverse events and laboratory data were collected. Results: After 14 days, mean EDSS improved from 3.4 ± 2.0 to 2.3 ± 2.0 (p=0.001), and visual acuity improved from 0.39 ± 0.33 to 0.66 ± 0.36 (p=0.01). Response rate was 64%. No relevant adverse events were observed. IA was effective even in patients with long latency since relapse, defined as a time of >6 weeks between first symptoms and treatment. Interpretation: Our data provide preliminary evidence that immunoadsorption with regenerating columns is an effective and well-tolerated treatment option for steroid-refractory MS and ON and might even be considered for patients with long latency since relapse. However, our results have to be confirmed by a randomized controlled trial with a higher number of subjects, and additional studies are needed to compare efficacy of IA and PE.