Nursing Protocols and Observed Outcomes of TR-350 Immunoadsorption in Neuromyelitis Optica Spectrum Disorder: A Single-Center Experience of 334 Procedures.

INTRODUCTION

We describe an institutional nursing protocol used for patients with neuromyelitis optica spectrum disorder (NMOSD) undergoing TR-350 tryptophan immunoadsorption (IA) therapy. We retrospectively analyzed the clinical and nursing records of 67 patients with NMOSD who underwent TR-350 IA between January 2019 and August 2025.

METHODS

We evaluated 334 treatment sessions and recorded demographic characteristics, observed clinical and serological changes, adverse events, and device alarms. Nursing management before, during, and after the procedure was reviewed.

RESULTS

After the IA treatment course, reductions in the median Expanded Disability Status Scale score and the geometric mean anti-aquaporin-4 immunoglobulin G (AQP4-IgG) titer, together with improvement in visual acuity, were observed. Laboratory testing revealed hypofibrinogenemia (<1.0 g/L) in 13 of 67 patients (19.4%). Nurses identified hypotension in two sessions (2/334, 0.6%) and catheter-site bleeding in one session (1/334, 0.3%); in all, 29 device-alarm events were recorded. With nursing intervention and timely troubleshooting, 333 of 334 sessions were completed; one session (0.3%) was terminated prematurely because of extracorporeal circuit clotting.

CONCLUSION

TR-350 IA demonstrated feasibility and safety in this cohort of patients with steroid-refractory NMOSD. Adherence to nursing protocols refined locally from institutional standard operating procedures and clinical experience, together with proactive management of complications, supported a high treatment completion rate and patient safety.