Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a devastating autoimmune disorder with cycles of escalating relapse. Rates of diagnosis in the elderly are increasing. Therapeutic decision-making is more challenging in elderly patients due to multiple comorbidities and high risk of drug...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-03-01
|
| Series: | Therapeutic Advances in Neurological Disorders |
| Online Access: | https://doi.org/10.1177/17562864231162420 |
| _version_ | 1797861427003785216 |
|---|---|
| author | Weihe Zhang Yujuan Jiao Lei Cui Yeqiong Zhang Jinsong Jiao Ming Jin Wei Yuan Yang You Renbin Wang Dantao Peng |
| author_facet | Weihe Zhang Yujuan Jiao Lei Cui Yeqiong Zhang Jinsong Jiao Ming Jin Wei Yuan Yang You Renbin Wang Dantao Peng |
| author_sort | Weihe Zhang |
| collection | DOAJ |
| description | Background: Neuromyelitis optica spectrum disorder (NMOSD) is a devastating autoimmune disorder with cycles of escalating relapse. Rates of diagnosis in the elderly are increasing. Therapeutic decision-making is more challenging in elderly patients due to multiple comorbidities and high risk of drug-induced side effects. Objective: This retrospective study assessed the efficacy and safety of standard plasma exchange (PLEX) treatment in an elderly population with NMOSD. Design: Seventy-six patients with NMOSD who received PLEX were apportioned to two groups as either elderly (⩾60 years, n = 26) or young (<60 years) at the time of the first procedure. Methods: Therapeutic response was judged according to functional recovery at 6 months, as reflected by Expanded Disability Status Scale (EDSS) and visual outcome scale (VOS) scores. Results: The mean age of the 26 elderly patients was 67.7 ± 7.9 years (range 60–87 years); the population was predominantly female (88.5%). PLEX sessions were generally well tolerated among the elderly. Compared with the young patients, the elderly had significantly more comorbidities and concomitant medications. Twenty-four (96.0%) elderly patients showed functional improvement at 6 months after PLEX, of which 15 (60.0%) experienced moderate-to-marked improvement. Six months after the initial PLEX treatment, the patients overall experienced a significant improvement in EDSS and VOS scores. Logistic regression showed that severe optic neuritis attack was a significant independent prognostic factor associated with poor PLEX response. The groups were comparable regarding overall or serious adverse events. The rate of transient hypotension was significantly higher in the elderly compared with the young. Conclusion: PLEX is an effective and safe therapy for elderly patients with NMOSD and should be considered a treatment option during NMOSD attacks. In the elderly, preventive measures against hypotension are recommended before PLEX. |
| first_indexed | 2024-04-09T22:02:19Z |
| format | Article |
| id | doaj.art-89d23d7b17f94ae987f03f397eeedcc8 |
| institution | Directory Open Access Journal |
| issn | 1756-2864 |
| language | English |
| last_indexed | 2024-04-09T22:02:19Z |
| publishDate | 2023-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Neurological Disorders |
| spelling | doaj.art-89d23d7b17f94ae987f03f397eeedcc82023-03-23T15:33:30ZengSAGE PublishingTherapeutic Advances in Neurological Disorders1756-28642023-03-011610.1177/17562864231162420Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational studyWeihe ZhangYujuan JiaoLei CuiYeqiong ZhangJinsong JiaoMing JinWei YuanYang YouRenbin WangDantao PengBackground: Neuromyelitis optica spectrum disorder (NMOSD) is a devastating autoimmune disorder with cycles of escalating relapse. Rates of diagnosis in the elderly are increasing. Therapeutic decision-making is more challenging in elderly patients due to multiple comorbidities and high risk of drug-induced side effects. Objective: This retrospective study assessed the efficacy and safety of standard plasma exchange (PLEX) treatment in an elderly population with NMOSD. Design: Seventy-six patients with NMOSD who received PLEX were apportioned to two groups as either elderly (⩾60 years, n = 26) or young (<60 years) at the time of the first procedure. Methods: Therapeutic response was judged according to functional recovery at 6 months, as reflected by Expanded Disability Status Scale (EDSS) and visual outcome scale (VOS) scores. Results: The mean age of the 26 elderly patients was 67.7 ± 7.9 years (range 60–87 years); the population was predominantly female (88.5%). PLEX sessions were generally well tolerated among the elderly. Compared with the young patients, the elderly had significantly more comorbidities and concomitant medications. Twenty-four (96.0%) elderly patients showed functional improvement at 6 months after PLEX, of which 15 (60.0%) experienced moderate-to-marked improvement. Six months after the initial PLEX treatment, the patients overall experienced a significant improvement in EDSS and VOS scores. Logistic regression showed that severe optic neuritis attack was a significant independent prognostic factor associated with poor PLEX response. The groups were comparable regarding overall or serious adverse events. The rate of transient hypotension was significantly higher in the elderly compared with the young. Conclusion: PLEX is an effective and safe therapy for elderly patients with NMOSD and should be considered a treatment option during NMOSD attacks. In the elderly, preventive measures against hypotension are recommended before PLEX.https://doi.org/10.1177/17562864231162420 |
| spellingShingle | Weihe Zhang Yujuan Jiao Lei Cui Yeqiong Zhang Jinsong Jiao Ming Jin Wei Yuan Yang You Renbin Wang Dantao Peng Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study Therapeutic Advances in Neurological Disorders |
| title | Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study |
| title_full | Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study |
| title_fullStr | Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study |
| title_full_unstemmed | Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study |
| title_short | Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study |
| title_sort | therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder a single center observational study |
| url | https://doi.org/10.1177/17562864231162420 |
| work_keys_str_mv | AT weihezhang therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy AT yujuanjiao therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy AT leicui therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy AT yeqiongzhang therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy AT jinsongjiao therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy AT mingjin therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy AT weiyuan therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy AT yangyou therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy AT renbinwang therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy AT dantaopeng therapeuticefficacyandsafetyofplasmapheresisinelderlypatientswithneuromyelitisopticaspectrumdisorderasinglecenterobservationalstudy |