Head-To-Head Intra Individual Comparison of Three Therapeutic Apheresis Modalities in Chronic Auto-Immune Neuropathy: A Real-World Experience.

Therapeutic apheresis (TA) is effective in autoimmune neurological disorders and is increasingly used due to intravenous immunoglobulin (IVIg) shortages. Although three modalities exist-membrane-based therapeutic plasma exchange (mTPE), centrifugal therapeutic plasma exchange (cTPE), and double-filtration plasmapheresis (DFPP)-comparative real-world data, especially within the same patients, remain scarce. We conducted a retrospective, intraindividual comparison of mTPE, cTPE, and DFPP in 72 sessions from five clinically stable chronic inflammatory demyelinating polyneuropathy patients. Outcomes included session duration, plasma removal efficiency (PRE), technical aspects, tolerance, clotting, and per-session costs. All sessions used peripheral venous access. cTPE achieved the highest PRE but required longer sessions. DFPP and mTPE enabled faster exchanges, but required more nursing input. Clotting occurred only with filtration modalities, mostly linked to intravenous calcium under citrate. All approaches were well tolerated, with no bleeding or relapses. DFPP was feasible with saline-only replacement, without causing hypotension. Session costs were lowest with cTPE, although the cost per liter was similar to that of DFPP. This is the first real-world study comparing all three modalities within the same patients. Each has distinct advantages and limitations. DFPP emerges as an efficient, cost-saving alternative, especially in settings with limited resources. These results support a tailored approach to TA, particularly as plasma exchange gains importance amid IVIg shortages.