Effectiveness and Outcome Predictors of Acute Plasma Exchange for Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease
Smathorn Thakolwiboon1, Vyanka Redenbaugh2, Bo Chen3, Sage Hewitt4, Shailee Shah5, Itay Lotan6, Michael Levy7, Mirasol Forcadela8, Saif Huda9, Julie Pique10, Romain Marignier11, Clémence Boutère12, Bertrand Audoin12, Pascale Poullin12, Dimitrios Champsas13, David Choi14, Helen Danesh-Meyer14, Elena Vasileiou15, Elias Sotirchos15, James Davis15, Amanda Henderson15, Adi Wilf-Yarkoni16, Hadas Stiebel-Kalish16, Elisabeth Maillart17, Laura Bonelli18, Anthony C. Arnold18, Marine Boudot de la Motte19, Romain Deschamps19, Jiraporn Jitprapaikulsan20, Heather Moss21, Sylvia Elizabeth Villarreal Navarro21, Yang Mao-Draayer22, Murli Mishra23, Nisa Vorasoot24, Laura Cacciaguerra2, Nanthaya Tisavipat2, Deena Tajfirouz2, Jan-Mendelt Tillema2, Alfonso Lopez2, Jacqueline Palace25, Yael Hacohen26, Sean Pittock27, Eoin Flanagan2, John Chen2
1Neurology, Mayo Clinic Health System, 2Mayo Clinic, 3John Radcliffe Hospital, University of Oxford, 4VUMC, 5Vanderbilt Multiple Sclerosis Center, 6Massachusetts General Hospital, 7Massachusetts General Hospital/Harvard Medical School, 8The Walton Centre NHS Foundation Trust, 9NHS, 10Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), 11Lyon University Hospital, 12University Hospital of Marseille, 13Institue of Neurology, UCL, 14University of Auckland, 15Johns Hopkins University, 16Tel Aviv University, 17Hôpital de la Pitié-Salpêtrière, 18University of California Los Angeles, 19Adolphe de Rothschild Foundation Hospital, 20Faculty of Medicine Siriraj Hospital, 21Stanford University, 22Oklahoma Medical Research Foundation, 23Vanderbilt University Medical Center, 24Khon Kaen University, 25John Radcliff Hospital Oxford Univeristy Hospitals Trust, 26Great Ormond Street Hospital, 27Mayo Clinic Dept of Neurology
Objective:
To evaluate the outcomes of PLEX for attacks in MOGAD
Background:
Multiple studies have shown PLEX effectiveness in severe acute attacks in CNS inflammatory diseases including MS and NMOSD. However, studies on PLEX in MOGAD remain limited.
Design/Methods:
This international multicenter retrospective cohort study included 243 attacks from 234 MOGAD patients who underwent PLEX from 18 tertiary care centers in 6 countries. We assessed the frequency of complete recovery (CR), clinically significant improvement (CSI), final visual acuity (VA) and Expanded Disability Status Scale (EDSS) at least 3 months post-attack. 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. The most common attack phenotypes were 161 optic neuritis (ON), 77 myelitis, 24 acute disseminated encephalomyelitis, and 15 brainstem/cerebellar. In addition to PLEX, 239 (99%) attacks received corticosteroids and 32 (13%) intravenous immunoglobulin. VA in ON attacks improved from 20/400 (20/70-hand motion) before PLEX to 20/20 (20/20-20/30), and EDSS of all attacks significantly decreased from a median of 4.0 (3.0-6.5) to 1.0 (0.0-2.5). 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% confidence interval) 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 probability of CSI.
Conclusions:
PLEX is associated with favorable outcomes in MOGAD attacks, particularly in young patients and when initiated early.
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