Journal
EUROPEAN NEUROLOGY
Volume 75, Issue 5-6, Pages 300-306Publisher
KARGER
DOI: 10.1159/000447059
Keywords
Multiple sclerosis; Steroid-refractory relapse; Escalation therapy; Tryptophan immunoadsorption; Plasma exchange
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Funding
- Bayer vital
- Biogen
- DIAMED
- Genzyme
- Novartis
- Pfizer
- Teva
- Merck Serono
- ASAHI Kasei Medical
- Ipsen
- Merz
- Merck-Serono
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Background: A marked proportion of multiple sclerosis (MS) relapses is followed by incomplete recovery. Our aim was to considerably increase the evidence of the clinical use of immunoadsorption (IA) as escalation therapy for patients with MS relapse. Methods: A retrospective multicenter study was performed in MS patients with steroid refractory relapse who were treated with tryptophan IA. The main outcome parameter was change of acute relapse-related disability assessed by Expanded Disability Status Scale (EDSS) and visual acuity (VA) measurements for patients with optic neuritis (ON). IA treatments were performed using single-use tryptophan adsorbers. Results: Data of 147 MS patients and 786 single IA treatments were analyzed. Treatment with IA was commenced in mean 32 +/- 35 days after the onset of relapse. One hundred and five out of 147 patients (71.4%) improved functionally after mean 5.4 IA treatments within 7-10 days. EDSS improved from median 5 (interquartile range, IQR 3.5) to 4 (IQR 2.5) (p < 0.001). In patients with ON (n = 32), VA improved after the IA series in 84% of cases from median 0.2 (IQR 0.6) to 0.6 (IQR 0.66) (p < 0.001). In 98.9% of IA treatments, no clinically relevant side effect was reported. Conclusion: Tryptophan IA was found to be effective and well tolerated as escalation therapy for MS relapse. (C) 2016 S. Karger AG, Basel
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