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New Guidelines for the Use of Plasma Exchange Therapy in MS

February 8, 2011

New guidelines from the American Academy of Neurology (AAN) recommend that clinicians consider using plasma exchange (also known as plasmapheresis, a blood-cleansing procedure) for a number of conditions for which it has shown benefit. In MS, the guidelines suggest it may be effective as a secondary therapy for exacerbations unresponsive to corticosteroids in people with relapsing forms of MS, and may be useful for severe, rapidly progressive MS and similar disorders (acute fulminant demyelinating CNS disease). The treatment was not found to be effective for secondary-progressive MS or primary-progressive MS. Irene Cortese, MD, and colleagues from the AAN’s Therapeutics and Technology Assessment Subcommittee published the guidelines in Neurology (2011;76(3):294-300).

Plasmapheresis is a process in which whole blood is withdrawn from an individual; the liquid portion or plasma is removed from the blood and replaced; and the blood, with all its red and white blood cells, is transfused back into the person. This process is a successful method for treating some autoimmune diseases such as myasthenia gravis and Guillain-Barré syndrome, because it removes the circulating antibodies that are thought to be active in these diseases.

Because MS may also involve an autoimmune process—where the body is attacked by its own immune system—and because damaging factors have been found in plasma from people with MS, plasmapheresis has been tried as a treatment for MS. The authors reviewed the medical literature from 1995 through 2009 to reassess the role of this strategy for treating neurologic disorders, and revised the previous set of AAN guidelines to include recommendations for MS.

The vast majority of people experiencing acute attacks respond well to the standard high-dose corticosteroid treatment. According to the guidelines, plasma exchange should be considered a treatment alternative only for the few who do not, and only for a short time. Potential side effects include infection and blood clotting problems.

Read summaries of the new guidelines from the AAN (PDFs) for clinicians (external link broken) and for patients.(external link broken)

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