Therapeutic plasma exchange (TPE) may help improve acute attacks of optic neuritis in patients with neuromyelitis optica spectrum disorder (NMOSD), according to a new study published in Therapeutic Apheresis and Dialysis.

Treatment with TPE following immunosuppressants resulted in an improvement on the visual acuity scale in 76.4% of acute attacks. A similar number of patients experienced improvement from TPE based on subjective improvement according to Keegan’s criteria (75.3%). An increase in visual acuity scale of 2 points or greater was observed in 45% of patients.

“TPE could improve neurological involvement during the acute attacks of NMOSD, as measured using visual acuity scale and Keegan’s criteria,” the authors said.

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Using bivariate analysis, age (P =.003) and pre-TPE visual acuity scale score (P =.005) were significantly correlated with a TPE response measured by a visual acuity scale improvement of 2 or greater or a return to normal visual acuity scale. Age (odds ratio [OR]=.90; 95% CI, .84-.97; P <.011) and pre-TPE visual acuity scale score (OR=1.75; 95% CI, 1.05-2.91; P <.03) were also significantly correlated with visual acuity scale response using multivariate analysis.

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Sex, number of previous flares, systemic autoimmune disease, anti-aquaporin-4 antibodies, time flare to TPE, plasma exchange dose, and session interval were other factors tested in multivariate analysis but were found to be not significant.

“Among the factors that predict response in the visual acuity scale score as an outcome, the age at TPE showed a negative relationship, and severe initial visual acuity scale was associated with the response to TPE. There was no association of previous immunosuppressive management with the response to TPE,” the authors said.

During the study, a total of 102 acute events were recorded from 83 patients between January 2011 and May 2019. The patients underwent a collective total of 558 TPE sessions. The majority of patients were female (73.5%) and the mean age at TPE was 40.8 years. The majority of cases involved unilateral optic nerve involvement (72.55%) with bilateral involvement occurring in 10.78% and spinal cord involvement in 16.67%.


Gonzalez G CA, Vargas A DC, Contreras KM V, et al. Therapeutic plasma exchange for optic neuritis attacks in patients with neuromyelitis optica spectrum disorders. Ther Apher Dial. Published online March 30, 2022. doi:10.1111/1744-9987.13844