Rituximab and IVIG added to plasma exchange improves the outcome of severe CNS demyelinating attacks: a retrospective study.
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Chico-Garcia Juan Luis, Morales de la Prida Moisés, Boix Lago Almudena, García-Domínguez José Manuel, Sepúlveda María, Martínez-Hernández Eugenia, Guasp Mar, Fonseca Elianet, Calvi Alberto, Alba-Isasi María Teresa, Albertí Blanca, Cid Joan, Lozano Miquel, Charry Paola, Rodríguez-Jorge Fernando, Sainz-Amo Raquel, Sainz de la Maza Susana, Monreal Enric, Villar Luisa Maria, Masjuan Jaime, Valero-López Gabriel, Millán-Pascual Jorge, Cuello Juan Pablo, Palacios Michael, Gifreu Fraixinó Ariadna, Martínez-Gins María Luisa, Álvarez Bravo Gary, Meca-Lallana José E, Costa-Frossard Lucienne, Blanco Yolanda, Cabrera-Maqueda Jose Maria, Saiz Albert, Llufriu Sara
Аннотация
OBJECTIVE: We aimed to determine the overall effectiveness of PE in severe demyelinating attacks, identify predictors of response, and compare outcomes between standard PE and RTX-IVIG-PE protocols.
DESIGN: Retrospective analysis of patients with CNS demyelinating attacks treated with PE between 2012 and 2023 across five Spanish hospitals.
METHODS: Clinical response was measured as an improvement or a complete recovery at discharge and 6 months. Uni- and multivariable logistic regression models were developed to identify predictors of PE response. A logistic regression analysis, after inverse probability of treatment weighting (IPTW), was performed to compare the outcome of attacks treated with standard PE and RTX-IVIG-PE.
RESULTS: A total of 162 attacks in 150 patients (81 multiple sclerosis; 37 others acquired demyelinating syndromes; 27 neuromyelitis optica spectrum disorder; 5 myelin oligodendrocyte glycoprotein antibody-associated disease; 73% female; median age 43 years (interquartile range 33-52.75)) were analyzed. At discharge, 60% of all attacks showed clinical improvement, and 15% achieved complete recovery. At 6 months, these rates increased to 77% and 31%, respectively. Younger age, lower preattack Expanded Disability Status Scale, and treatment with RTX-IVIG-PE were independent predictors of complete recovery at 6 months. IPTW analysis showed that attacks treated with RTX-IVIG-PE (33) were associated with improvement (adjusted odds ratio (aOR) 5.4, p < 0.001) and complete recovery (aOR 4.55, p < 0.001) at 6 months compared to those treated with standard PE (129), without significant differences in the adverse event profile between the two protocols.
CONCLUSION: PE improves the outcome of steroid-refractory CNS demyelinating attacks, and the addition of rituximab and IVIG to PE may increase the likelihood of long-term recovery.