Efficacy of fresh frozen plasma and human albumin in therapeutic plasma exchange for refractory neuromyelitis optica spectrum disorders and multiple sclerosis exacerbation: A two-tertiary care center study.

BACKGROUND: Therapeutic plasma exchange (TPE) is an established rescue therapy for steroid-refractory demyelinating attacks in neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). The optimal replacement fluid for TPE-human albumin or fresh frozen plasma (FFP)-remains uncertain, particularly in resource-limited settings.

METHODS: We conducted a retrospective cohort study at two tertiary care centers in Thailand, comparing the efficacy and safety of albumin versus FFP as replacement fluids in TPE. Adult patients with NMOSD or MS experiencing refractory exacerbation were included. Clinical outcomes were evaluated using the Expanded Disability Status Scale (EDSS) and Opticospinal Impairment Scale (OSIS), including visual and motor subscales, at baseline, post-treatment, day 90, and day 180. The primary outcome was the proportion of patients achieving favorable functional outcome (EDSS < 6) at day 180.

RESULTS: Among 67 patients (97 % NMOSD), 41 received albumin and 26 received FFP. At day 180, 75.6 % in the albumin group and 73.1 % in the FFP group achieved a favorable outcome (P = 1.00). EDSS and OSIS scores improved significantly in both groups over time, with albumin associated with greater motor recovery and FFP with superior visual improvement. Adverse events were mild and comparable between groups.

CONCLUSION: TPE using either albumin or FFP is effective and safe for treating steroid-refractory NMOSD and MS. Given that FFP is more readily available and often less costly than albumin, especially in developing countries, it may serve as a practical alternative in resource-limited healthcare settings.