Advanced plasma exchange therapy effectively eases NMOSD attacks
Study: DFPP has fewer side effects than high-dose corticosteroid treatment
Double-filtration plasmapheresis (DFPP), an advanced blood-cleaning procedure, is equally effective as high-dose corticosteroids for treating acute attacks associated with neuromyelitis optica spectrum disorder (NMOSD), but comes with fewer side effects, according to a new study from China.
DFPP selectively removes disease-driving self-reactive antibodies from the bloodstream while retaining beneficial components. Corticosteroids, a type of anti-inflammatory and immunosuppressive treatment, are commonly used to treat acute NMOSD attacks.
A combination of DFPP plus high-dose corticosteroids was particularly effective among NMOSD patients with severe disability before treatment, according to the data.
“These findings support DFPP as a viable therapeutic option, particularly for patients with high [initial] disability or [contraindications to high-dose steroids],” researchers wrote.
The study, “Comparative Efficacy of Double-Filtration Plasmapheresis Versus Intravenous Methylprednisolone in Acute Attacks of Neuromyelitis Optica Spectrum Disorder: A Prospective Cohort Study,” was published in Neurology and Therapy.
NMOSD characterized by inflammatory attacks on spinal cord, optic nerve
NMOSD is a progressive autoimmune disease characterized by inflammatory attacks on the spinal cord and the optic nerve, which transmits visual signals from the eyes to the brain. Most cases are caused by self-reactive antibodies against the protein AQP4.
Most people with NMOSD experience a relapsing-remitting course, marked by episodes of inflammation and symptom worsening, known as relapses or attacks, followed by periods of recovery. Each relapse causes additional nerve damage, and over time, this damage accumulates and leads to disabilities such as blindness or paralysis.
Acute NMOSD attacks are typically treated with high-dose corticosteroids, such as methylprednisolone, administered directly into the bloodstream, or intravenously. While these medications help reduce inflammation and prevent nerve damage, prolonged use can lead to several side effects, including weight gain, mood swings, infections, and bone thinning.
Plasma exchange therapy (PLEX) is also used to treat acute NMOSD attacks. It’s a procedure that removes and replaces a patient’s blood to help reduce the levels of harmful large-molecule substances, including self-reactive antibodies. PLEX is particularly useful among people with steroid-refractory disease, meaning it doesn’t adequately respond to corticosteroids.
DFPP is an alternative to PLEX that utilizes two filters to selectively remove self-reactive antibodies from the blood while retaining beneficial blood components. It can help reduce the risk of complications, such as allergic reactions or infections, associated with the use of donor blood.
Although studies have demonstrated the effectiveness of intravenously administered methylprednisolone (IVMP) and PLEX to ease acute NMOSD attacks, little is known about the impact of DFPP. This is especially true in Asian populations, which have higher rates of NMOSD.
Advanced plasma exchange therapy shows a favorable safety profile
To address this gap, a team of researchers in China directly compared DFPP versus IVMP to treat acute NMOSD attacks, focusing on disability outcomes and side effects.
“By addressing the gap in comparative evidence, our findings may inform clinical decision-making, particularly for patients with high [initial] disability or steroid-refractory disease,” the team wrote.
Of the 146 adults with NMOSD assessed in the study, the vast majority were women (84.2%). Most (69.9%) had previously received immunosuppressive treatments, primarily mycophenolate mofetil (sold as CellCept, with generics available). Among them, 65 received IVMP, 21 underwent DFPP, and 60 received a combination of IVMP plus DFPP.
The study’s primary goal was to assess changes in disability, as assessed by the Expanded Disability Status Scale (EDSS).
Results showed that the proportion of NMOSD patients who achieved an EDSS score reduction, reflecting less severe disability, was similar between the IVMP alone (69.2%), DFPP alone (66.7%), and IVMP plus DFPP groups (66.7%). All three groups demonstrated a median drop of 0.5 points in EDSS scores.
The response rates for IVMP and DFPP were also similar among patients who tested positive for anti-AQP4 antibodies or those presenting with a first attack.
DFPP demonstrates comparable efficacy to IVMP in the acute management of NMOSD, with a favorable safety profile.
The team noted that the combination therapy achieved comparable results in patients with significantly higher initial disability, “suggesting its particular utility in severe cases.”
In secondary measures, DFPP, alone or in combination with IVMP, led to reductions in blood levels of self-reactive antibodies and improvements in functional status, as indicated by modified Rankin Scale scores.
In the safety assessment, the rates of adverse events in the entire DFPP group (both DFPP and DFPP plus IVMP) were lower than those in the group that received IVMP alone (19.8% vs. 33.8%), although these differences did not reach statistical significance.
After DFPP, the most frequent adverse events were a short-term rise in liver enzymes (9.9%), a sign of liver injury, minor infections (6.2%), and reduced platelet levels (3.7%), which are circulating cell fragments that help blood clot. No cases required further medical intervention or resulted in bleeding, and there were no treatment discontinuations.
“DFPP demonstrates comparable efficacy to IVMP in the acute management of NMOSD, with a favorable safety profile,” the researchers concluded. “Further research is needed to optimize treatment protocols and identify predictors of response.”
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