Plasma Exchange Should Be Used With Caution in Progressive Multifocal Leukoencephalopathy

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There was no association between receiving steroids prophylactically versus therapeutically and IRIS latency or duration.
There was no association between receiving steroids prophylactically versus therapeutically and IRIS latency or duration.

HealthDay News — For patients with progressive multifocal leukoencephalopathy (PML), plasma exchange (PLEX) and steroids should be used with caution, according to a study published online in the Annals of Neurology.

Cristina Scarpazza, PhD, from the Multiple Sclerosis Center of Spedali Civili in Italy, and colleagues examined clinical and radiological data from 42 patients with natalizumab-related PML. Data were available through 12 months after diagnosis of PML.

The researchers found that PLEX treatment was not associated with PML-immune reconstitution inflammatory syndrome (IRIS) latency (hazard ratio [HR], 1.05; P =.92); once IRIS emerged, its duration was significantly longer in patients who underwent PLEX (101 days compared with 54 days in PLEX- patients; P =.028). 

There was no association between receiving steroids prophylactically versus therapeutically and IRIS latency (HR, 0.67; P =.39) or duration (P =.95). Patients who received steroids prophylactically had a significantly higher increase in the Expanded Disability Status Scale (EDSS) than those who received steroids therapeutically (0.09 EDSS points per month; P =.04).

"We are aware that present data should be considered only hypothesis-generating and need to be confirmed in future studies possibly based on prospective data collection and larger sample sizes," the authors write.

Several authors disclosed financial ties to Biogen, the pharmaceutical company that produces natalizumab.

Reference

Scarpazza C, Prosperini L, De Rossi N, et al. To do or not to do? Plasma exchange and timing of steroid administration in PML [published online October 11, 2017]. Ann Neurol. doi:10.1002/ana.25070



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