Beneficial effect of plasma exchange in acute attack of neuromyelitis optica spectrum disorders

Plasma exchange (PLEX) is routinely performed in neuromyelitis optica spectrum disorders (NMOSD) patients with an acute attack who do not respond to corticosteroids treatment. To compare treatment outcomes in NMOSD patients with an acute attack between the two groups. We retrospectively studied 67 attacks from 52 NMOSD patients. Outcome measurements using Expanded Disability Status Scale (EDSS), modified Rankin Scale (mRS) were compared. There were 23 IVMP responders, 16 IVMP non-responders refusing PLEX, 12 IVMP non-responders/PLEX responders, and 16 IVMP/PLEX non-responders. The IVMP-responders showed faster improvement since the time of discharge but seemed to have less treatment benefit over time. However, IVMP non-responders/PLEX responders showed continuous and maximum improvement at 6 months (ΔEDSS from nadir: 1 for IVMP-responders vs 0.5 for IVMP non-responders without PLEX vs 2.75 IVMP non-responders/PLEX-responders vs 0.5 IVMP/PLEX non-responders; p = 0.49) and had comparable outcomes to the IVMP-responders (nadir EDSS 8.0 to 5.25 [ΔEDSS = 2.75] vs nadir EDSS 6.5 to 5.0; [ΔEDSS = 1.5], respectively). Add - on PLEX treatment in NMOSD patients with an acute attack should be considered in those not responding to IVMP alone. •Benefit of plasma exchange vs pulse steroid treatment was reviewed in Asian NMOSD.•Either IVMP or IVMP+PLEX showed neurological improvement in acute attacks of NMOSD.•Add-on PLEX should be considered in NMOSD who were not responsive to IVMP alone.