Timing of plasma exchange for neuromyelitis optica spectrum disorders: A meta-analysis

BackgroundNeuromyelitis optica spectrum disorders (NMOSDs) are autoimmune astrocytopathies with predominant involvement of the optic nerves and spinal cord. The current management is high-dose intravenous methylprednisolone, followed by apheresis therapy if it fails. We aimed to investigate plasma exchange (PE) benefits in corticosteroid-refractory NMOSDs.MethodsFrom Embase, PubMed, Cochrane, Web Science, Clinical Trials, we identified PE-based studies published between Jan 2007 Dec 2019. pooled information these a binomial meta-analysis. investigated factors affecting efficacy PE its adverse events. effectiveness was assessed using Expanded Disability Status Scale (EDSS). timing initiation Spearman correlation analysis.ResultsWe included 561 records 8 observational studies, including 228 NMOSD patients. mean time 11 days, average volume each 1.5–2 L. treatment reduced EDSS score ?1.04 (95% CI, ?1.44 ?0.64). significantly affected outcome (EDSS reduction) (P = 0.01; 95% ?1.30 0.28). In ? 7-day 8–23-day groups, decreased 0.64 ?0.93 ?0.34) 1.41 ?1.79 ?1.02), respectively. addition, showed same for alleviating symptoms NMOSDs, regardless day 23 days on which performed 0.29). Thirty-five (20.8%) 168 patients had events.ConclusionPE can ameliorate severe NMOSDs. associated duration disease PE, optimal after onset disease.