A Retrospective Comparison of Plasma Exchange Versus Corticosteroids in Acute Relapsing Multiple Sclerosis

Treatment of acute multiple sclerosis (MS) relapses has remained largely unaltered for decades. Standard treatment for acute relapses is high-dose intravenous (methyl-) prednisolone (IVMPS, 1000mg per day given for 3-5 days). However, approximately one quarter of patients remain with significant disability after one course of IVMPS. For treatment of these patients, apart from extending steroid treatment, apheresis treatments were considered as an alternative in MS relapses. Unfortunately, data on comparison of both regimens are still missing. We set up a retrospective analysis to investigate the efficacy of TPE vs. increased dosages of IVMPS in steroid refractory MS relapses, includingpatients being treated between January, 2013 and December, 2016. In-depth medical-chart review was performed. Baseline data were compared and treatment outcomes were analyzed using logistic regression models. 193 patients were identified. 99 received asecond course of IVMPS as first escalation treatment and 46 were directly subjected to TPE. 53 Patients received TPE after their second course of IVMPS. Baseline characteristics between different treatment groups were evenly balanced. After TPE, a higher proportion ofpatients experienced marked or full response and these effects were preserved at follow-up. However, those effects vanished, if TPE was performed after two courses of IVMPS and this effect was apparently independent of time to initiation of apheresis treatment. Our findings indicate that early TPE has particular advantages compared to a second course of IVMPS. However, data from prospective, randomized trial in a well-defined cohort are desirable. Classification of Evidence: These findings provide Class IV evidence that for patients,refractory to a first course of IVMPS, TPE has particular advantages compared to a second course of IVMPS