The use of therapeutic plasma exchange (TPE) may be a better treatment option for patients with neuromyelitis optica spectrum disorder (NMOSD) than intravenous immunoglobulin (IVIg), according to a review published in Therapeutic Advances in Neurological Disorders.

The review compared studies of the efficacy of TPE and IVIg for several autoimmune neurological conditions, including NMOSD, myasthenia gravis (MG), Guillain–Barré syndrome (GBS), chronic immune–mediated polyradiculoneuropathy (CIDP), encephalitis, and other conditions.

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It did not identify any studies that directly compared the 2 treatments. However, it did report on 3 studies that found that TPE was effective at treating NMOSD attacks, the researchers noted. One of the studies, a prospective controlled study, found that it was most efficacious when administered with intravenous steroids rather than as an add-on therapy, they added.

Another study found that TPE was most effective when initiated immediately. The study found that patients who had TPE initiated on day 0 had a 50% chance of complete improvement compared to only 1% to 5% for patients with a treatment delay of 20 days.

For IVIg, 2 studies were identified in the review. The first showed that roughly half (5/11) of patients with NMOSD experiencing an acute event improved with IVIg, although improvements in the Expanded Disability Status Score were insignificant. A moderate benefit was observed in another study for patients who received IVIg. The study also found that combining IVIg with high-dose intravenous steroids provided some relief to the onset of severe NMOSD.

In addition to NMOSD, the review article examined TPE and IVIg in several other neurological conditions, including MG. For MG, 8 out of 11 reviewed studies found TPE and IVIg to be equally effective for treatment. Two of the studies found that TPE was more efficacious than IVIg. The remaining research favored IVIg for shorter patient intubation times during MG treatment.

“TPE and IVIg are both viable treatment options for several autoimmune neurological disorders: GBS, MG (including myasthenic crisis), CIDP, and encephalitis. For NMOSD, the evidence from the targeted literature review favored TPE over IVIg, although some studies point to a potential benefit of IVIg,” the authors concluded.


Pinto AA, De Seze J, Jacob A, et al. Comparison of IVIg and TPE efficacy in the treatment of neurological disorders: a systematic literature review. Ther Adv Neurol Disord. Published online March 29, 2023. doi:10.1177/17562864231154306