Background

Therapeutic plasma exchanges (TPE) has been recommended for neuromyelitis optica spectrum disorders (NMOSD) as a rescue therapy after nonresponding from the high-dose steroid and as an early therapy in severe attacks. We performed a systematic review to evaluate whether therapeutic plasma exchange (TPE) is better than conventional intravenous methylprednisolone (IVMP) in neuromyelitis optica spectrum disorders (NMOSD) patients.

Methods

Systematic search was conducted in five databases: PubMed, Embase, Scopus, Web of Science, and CENTRAL for randomized controlled trials and observational studies of TPE compared to intravenous steroid in NMOSD patients with neurological or visual outcomes in English without publication date restriction. Quality assessment was performed using ROB2 and ROBINS-I. The meta-analysis was done using a random-effects model. Pooled risk ratio (RR) or mean difference with a 95% CIs of efficacy outcomes included the Expanded Disability Status Scale (EDSS), visual acuity, and LogMAR were measured.

Results

Of 3439 potential studies, seven were included in the systematic review (1211 attacks; 433 patients) and three studies were included in the meta-analysis. Compared to high dose steroid alone, the add-on TPE increases a chance for the returning of EDSS to baseline at discharge (RR 3.02, 95% CI 1.34–6.81) and last follow-up (RR 1.68, 95% CI 1.01–2.79) as well as improves visual acuity at last follow-up.

Conclusion

TPE as an add-on therapy to high-dose steroid injection during an acute attack in NMOSD patients is associated with returning to baseline EDSS at discharge and last follow-up, and a trend to have a lower disability at 6–12 months.

中文翻译：

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治疗性血浆置换与静脉注射高剂量类固醇治疗视神经脊髓炎谱系障碍 (NMOSD) 的常规治疗对比：系统评价和荟萃分析

背景

治疗性血浆置换 (TPE) 已被推荐用于视神经脊髓炎谱系疾病 (NMOSD)，作为大剂量类固醇无反应后的抢救疗法和严重发作的早期疗法。我们进行了一项系统评价，以评估治疗性血浆置换 (TPE) 在视神经脊髓炎谱系疾病 (NMOSD) 患者中是否优于常规静脉注射甲基强的松龙 (IVMP)。

方法

在五个数据库中进行了系统搜索：PubMed、Embase、Scopus、Web of Science 和 CENTRAL，用于随机对照试验和观察性研究 TPE 与静脉注射类固醇在 NMOSD 患者中的神经或视觉结果英语，不受出版日期限制。使用 ROB2 和 ROBINS-I 进行质量评估。荟萃分析是使用随机效应模型进行的。汇总风险比 (RR) 或与 95% CI 的疗效结果的平均差异包括扩展残疾状态量表 (EDSS)、视力和 LogMAR 进行了测量。

结果

在 3439 项潜在研究中，7 项纳入系统评价（1211 次发作；433 名患者），3 项研究纳入荟萃分析。与单独使用高剂量类固醇相比，附加 TPE 增加了出院时 (RR 3.02, 95% CI 1.34–6.81) 和末次随访 (RR 1.68, 95% CI 1.01–2.79) EDSS 恢复基线的机会) 以及在最后一次随访时提高视力。

结论

在 NMOSD 患者急性发作期间，TPE 作为高剂量类固醇注射的附加疗法与在出院和最后一次随访时恢复基线 EDSS 相关，并且在 6-12 个月时有降低残疾的趋势。