Standard plasma exchange is safe and effective for the treatment of elderly patients with neuromyelitis optica spectrum disorders (NMOSD), according to a new study published in the journal Therapeutic Advances in Neurological Disorders.

It should, therefore, be considered a treatment option during NMOSD attacks in this group of patients, according to the study authors.

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To test the safety and efficacy of plasma exchange in elderly patients with NMOSD, who are usually at a higher risk of side effects caused by treatments compared to younger patients, a team of researchers from China conducted a retrospective study. 

They analyzed a total of 76 patients with NMOSD who were treated with standard plasma exchange. They divided the patients into 2 groups based on their age. Those in the first group (n=26) were 60 years of age or above, while those in the second group (n=50) were 60 years of age or under when they first received the treatment.

The results showed that plasma exchange was generally well tolerated by elderly patients even though they had significantly more comorbidities and were using other medications than the younger patients. 

Almost all elderly patients (96%) had improved Expanded Disability Status Scale and visual outcome scale scores 6 months after plasma exchange treatment. The majority of the functional improvements (60%) were moderate-to-marked. 

The researchers found that severe optic neuritis attack was a significant independent prognostic factor associated with poor response to plasma exchange treatment. 

There were no significant differences between the 2 groups of patients in terms of overall and serious adverse events following plasma exchange treatment, but the rate of transient low blood pressure was significantly higher in elderly patients compared to the others. 

The researchers concluded that preventative measures against low blood pressure should be taken before the procedure in elderly patients with NMOSD.

Reference

Zhang W, Jiao Y, Cui L, et al. Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study. Ther Adv Neurol Disord. Published online March 23, 2023. doi:10.1177/17562864231162420