Outcomes After Acute Plasma Exchange for Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.
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Thakolwiboon Smathorn, Redenbaugh Vyanka, Chen Bo, Hewitt Sage, Shah Shailee, Lotan Itay, Levy Michael, Forcadela Mirasol, Huda Saif, Pique Julie, Marignier Romain, Boutiere Clemence, Audoin Bertrand, Poullin Pascale, Champsas Dimitrios, Choi David, Danesh-Meyer Helen V, Vasileiou Elena, Sotirchos Elias S, Davis James B, Henderson Amanda D, Wilf-Yarkoni Adi, Stiebel-Kalish Hadas, Maillart Elisabeth, Bonelli Laura, Arnold Anthony C, Boudot De La Motte Marine, Deschamps Romain, Jitprapaikulsan Jiraporn, Moss Heather E, Villarreal Navarro Sylvia E, Mao-Draayer Yang, Mishra Murli, Vorasoot Nisa, Cacciaguerra Laura, Tisavipat Nanthaya, Tajfirouz Deena A, Tillema Jan-Mendelt, Lopez-Chiriboga Sebastian A, Palace Jacqueline, Hacohen Yael, Pittock Sean J, Flanagan Eoin P, Chen John J
Аннотация
METHODS: This international multicenter retrospective cohort study included patients from 18 tertiary care centers in 6 countries. Inclusion criteria included fulfillment of the 2023 International MOGAD panel criteria, receipt of at least 3 sessions of PLEX, and follow-up of ≥3 months after PLEX. Patients with coexisting neuroinflammatory disorders were excluded. We assessed the frequency of complete recovery (CR), clinically significant improvement (CSI), visual acuity (VA), and Expanded Disability Status Scale (EDSS). Logistic regression analyses were performed to identify predictors of CR and CSI.
RESULTS: Of 234 patients, 135 (58%) were female. The median (interquartile range [IQR]) age at attack was 34 (IQR 22-49) years, and 42 (17%) were children. In 165 of 243 (68%), the attack treated with PLEX was the first attack. Attack phenotypes included 161 optic neuritis (235 eyes), 77 myelitis, 24 acute disseminated encephalomyelitis, 15 brainstem/cerebellar, 3 cerebral-cortical encephalitis attack, and 1 cerebral polyfocal deficit-36 with >1 core phenotypes. A total of 239 (99%) attacks were also treated with corticosteroids and 32 (13%) with IV immunoglobulins. VA in optic neuritis improved from 20/400 (20/70-hand motion) to 20/20 (20/20-20/30), p < 0.001, and EDSS decreased from a median of 4.0 (3.0-6.5) to 1.0 (0.0-2.5), p < 0.001. Of 229 attacks without subsequent attacks within 3 months, 100 (44%) achieved CR and 213 (93%) CSI. The probability of CR was decreased with advanced age (adjusted odd ratio [95% CI] 0.97 [0.96-0.99] per year), higher EDSS worsening from baseline (0.66 [0.54-0.81] per 0.5 increment) and delayed PLEX (0.98 [0.96-0.99] per day). Advanced age (0.97 [0.96-0.99] per year) and delayed PLEX (0.95 [0.94-0.96] per day) decreased the probability of CSI.
DISCUSSION: We observed favorable outcomes after PLEX in MOGAD attacks. However, advanced age and delayed initiation of PLEX were associated with a reduced probability of improvement. The absence of a control group limits our ability to differentiate PLEX effects from spontaneous recovery, prior corticosteroid response, or long-term immunotherapy. Future prospective studies are needed to assess the impact of PLEX on improvement.
CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that PLEX is associated with favorable clinical outcomes in patients with MOGAD.