PMID- 32899499
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201027
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 9
IP  - 9
DP  - 2020 Sep 5
TI  - Safety and Tolerability of Plasma Exchange and Immunoadsorption in 
      Neuroinflammatory Diseases.
LID - 10.3390/jcm9092874 [doi]
LID - 2874
AB  - Plasma exchange (PE) and immunoadsorption (IA) are frequently used for treatment 
      of various autoimmune-mediated neurological diseases, including multiple 
      sclerosis (MS), chronic inflammatory demyelinating polyneuropathy (CIDP), and 
      Guillain-Barre syndrome (GBS). Although both methods are generally regarded as 
      well-tolerated treatment options, evidence for safety and tolerability is low for 
      most indications and largely relies on small case series. In this study, we 
      retrospectively analysed adverse events (AEs) and laboratory changes in 284 
      patients with various neurological indications who received either PE (n = 65, 
      113 cycles) or IA (n = 219, 435 cycles) between 2013 and 2020 in our Neurology 
      department. One standard treatment cycle for PE as well as IA consisted of five 
      treatments on five consecutive days. During every treatment, the 2.0-2.5-fold 
      individual plasma volume (PV) was treated in IA, while in PE, the 0.7-fold 
      individual PV was replaced by human albumin solution. Overall, both methods 
      showed an excellent safety profile; no deaths of life-threatening adverse events 
      were recorded. Severe AEs (corresponding to grade 3 on the Common Terminology 
      Criteria for Adverse Events grading scale v5.0) including three patients with 
      sepsis, one pneumonia, and one pneumothorax were present in 5/435 IA cycles 
      (1.1%); in the PE group, no severe AEs were recorded. Furthermore, although 
      advantageous tolerability is generally considered the main advantage of IA over 
      PE, we found that overall frequency of AEs (including grades 1 and 2) was higher 
      in IA (67.1% of all cycles) compared to PE (35.4%; p < 0.001). The low incidence 
      of AEs in PE might be caused by the lower PV exchanged during each treatment 
      (0.7-fold) compared to previous studies which predominantly exchanged the 
      1.0-1.5-fold PV. In order to verify this hypothesis as well as confirming the 
      efficacy of this lower-dosed scheme, prospective studies comparing different 
      treatment regimens are needed.
FAU - Dorst, Johannes
AU  - Dorst J
AUID- ORCID: 0000-0001-6352-0909
AD  - Department of Neurology, University of Ulm, 89081 Ulm, Germany.
FAU - Fillies, Frank
AU  - Fillies F
AD  - Department of Neurology, University of Ulm, 89081 Ulm, Germany.
FAU - Dreyhaupt, Jens
AU  - Dreyhaupt J
AUID- ORCID: 0000-0001-8057-161X
AD  - Institute for Epidemiology and Medical Biometry, University of Ulm, 89081 Ulm, 
      Germany.
FAU - Senel, Makbule
AU  - Senel M
AUID- ORCID: 0000-0002-2737-7495
AD  - Department of Neurology, University of Ulm, 89081 Ulm, Germany.
FAU - Tumani, Hayrettin
AU  - Tumani H
AD  - Department of Neurology, University of Ulm, 89081 Ulm, Germany.
LA  - eng
PT  - Journal Article
DEP - 20200905
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC7565027
OTO - NOTNLM
OT  - chronic inflammatory demyelinating polyneuropathy
OT  - immunoadsorption
OT  - multiple sclerosis
OT  - neurological diseases
OT  - therapeutic plasma exchange
COIS- J.D. (Johannes Dorst) received honoraria and research grants from Fresenius 
      Medical Care GmbH and Fresenius Medical Care Deutschland GmbH. MS has received 
      consulting and/or speaker honoraria from Alexion, Bayer, Biogen, Merck, Roche, 
      and Sanofi Genzyme. She has received travel funding from Celgene, and TEVA. She 
      has received research funding from the Hertha-Nathorff-Program. H.T. reports 
      funding for research projects, lectures, and travel from Bayer, Biogen, Genzyme, 
      Merck, Novartis, Roche, Teva, and received research support from DMSG and BMBF. 
      F.F. and J.D. (Jens Dreyhaupt) report no conflicts of interest.
EDAT- 2020/09/10 06:00
MHDA- 2020/09/10 06:01
PMCR- 2020/09/05
CRDT- 2020/09/09 01:03
PHST- 2020/08/13 00:00 [received]
PHST- 2020/08/25 00:00 [revised]
PHST- 2020/09/03 00:00 [accepted]
PHST- 2020/09/09 01:03 [entrez]
PHST- 2020/09/10 06:00 [pubmed]
PHST- 2020/09/10 06:01 [medline]
PHST- 2020/09/05 00:00 [pmc-release]
AID - jcm9092874 [pii]
AID - jcm-09-02874 [pii]
AID - 10.3390/jcm9092874 [doi]
PST - epublish
SO  - J Clin Med. 2020 Sep 5;9(9):2874. doi: 10.3390/jcm9092874.