Frontiers in neurology · 2025
Intermittent immunoadsorption in critically ill patients with neuroimmunological disorders: a retrospective study.
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Wu Qian, Zhu Lin, Dai Shujuan, Xu Jing, Ge Deshan
Аннотация
OBJECTIVES: This study aimed to evaluate the efficacy and safety of intermittent immunoadsorption (IA) in critically ill patients with refractory autoimmune neurological disorders.
METHODS: We retrospectively reviewed 13 patients admitted to the neurocritical care unit with severe autoimmune encephalitis, Guillain-Barré syndrome, neuromyelitis optica spectrum disorders, or chronic inflammatory demyelinating polyneuropathy, all of whom had failed first-line immunotherapy (intravenous methylprednisolone and/or intravenous immunoglobulin). IA was administered intermittently, with schedules individualized based on clinical status.
RESULTS: The modified Rankin Scale (mRS) improved significantly following IA (p = 0.02), while the Acute Physiology and Chronic Health Evaluation II scores (APACHE II) remained stable (p = 0.95). Serum IgG levels declined by a median of 55.6%. Pathogenic antibody negativity was achieved in 65% of plasma and 38% of cerebrospinal fluid samples. Although 92% experienced treatment interruptions (e.g., infection and hypotension), IA was generally well tolerated and not permanently discontinued.
DISCUSSION: This study supports the feasibility and clinical utility of intermittent IA in critically ill patients with treatment-refractory neuroimmunological disorders. Despite frequent complications, flexible scheduling allowed continued therapy with sustained benefit. These findings highlight a potentially adaptable treatment strategy in a population often excluded from therapeutic interventions and suggest that IA warrants further study in neurocritical care settings.
METHODS: We retrospectively reviewed 13 patients admitted to the neurocritical care unit with severe autoimmune encephalitis, Guillain-Barré syndrome, neuromyelitis optica spectrum disorders, or chronic inflammatory demyelinating polyneuropathy, all of whom had failed first-line immunotherapy (intravenous methylprednisolone and/or intravenous immunoglobulin). IA was administered intermittently, with schedules individualized based on clinical status.
RESULTS: The modified Rankin Scale (mRS) improved significantly following IA (p = 0.02), while the Acute Physiology and Chronic Health Evaluation II scores (APACHE II) remained stable (p = 0.95). Serum IgG levels declined by a median of 55.6%. Pathogenic antibody negativity was achieved in 65% of plasma and 38% of cerebrospinal fluid samples. Although 92% experienced treatment interruptions (e.g., infection and hypotension), IA was generally well tolerated and not permanently discontinued.
DISCUSSION: This study supports the feasibility and clinical utility of intermittent IA in critically ill patients with treatment-refractory neuroimmunological disorders. Despite frequent complications, flexible scheduling allowed continued therapy with sustained benefit. These findings highlight a potentially adaptable treatment strategy in a population often excluded from therapeutic interventions and suggest that IA warrants further study in neurocritical care settings.