Apheresis Associated With Clinical Improvement in Early Active Multiple Sclerosis
In patients with pattern 3 disease, the longer delay to initiation of plasma exchange treatment may have affected the therapeutic outcome.
In patients with histologically proven inflammatory demyelination consistent with multiple sclerosis (MS) and 1 and 2 immunopathological demyelination lesion patterns, apheresis treatment (eg, plasma exchange [PLEX] and immunoadsorption [IA]) are associated with high response and lesion regression, according to study findings published in JAMA Neurology.
A total of 69 patients were enrolled in this single-center cohort study, all of whom had been diagnosed with early active inflammatory demyelination consistent with MS. Participants were categorized on the basis of their lesion pattern (pattern 1 [n=16], pattern 2 [n=40], and pattern 3 [n=13]), as identified on brain biopsy analysis. All patients underwent either PLEX or IA treatments, and investigators evaluated the effects of these treatments on the functionally relevant improvement in neurological systems within 30 days after therapy, with a focus on improvement of relapse-related neurological deficit.
Among the patients exhibiting pattern 1, 2, and 3 disease, functional therapy responses were observed in 31%, 55%, and 0% of patients, respectively (pattern 2 vs 3: P <.001). A greater proportion of patients with pattern 2 disease demonstrated greater radiological improvements and lesion regression than those with pattern 3 (56% vs 11%, respectively; P =.03).
Rates of response were also greater among patients with pattern 1 and 2 disease vs pattern 3 disease, as assessed by the Expanded Disability Status Scale scores (25% and 40% vs 0%, respectively). Immunoadsorption was found to be a probable positive predictor for functional therapy response (logarithmic odds ratio, 3.26; 95% CI, 0.75-8.13; P =.01), whereas brainstem involvement was deemed a negative predictive factor (logarithmic odds ratio, −1.43; 95% CI, −3.21 to 0.17; P =.03).
In patients with pattern 3 disease, the longer delay to initiation of PLEX treatment may have affected the therapeutic outcome. In addition, this study was unable to verify whether the findings may be applicable for lesion locations other than those found with brain biopsies.
Findings from this small study indicate that "histopathological patterns and possibly also factors associated with IA, brainstem involvement, and disturbed cognitive functions" may play a role in response to apheresis therapy, and these factors may be important to assess for planning treatment.
Stork L, Ellenberger D, Beißbarth T, et al. Differences in the responses to apheresis therapy of patients with 3 histopathologically classified immunopathological patterns of multiple sclerosis [published online February 5, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2017.4842