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No randomized controlled clinical trial of therapeutic plasma exchanges (TPE) has yet been performed for moderate-to-severe relapses of multiple sclerosis (MS). To compare TPE to sham-TPE in patients with a recent steroid-resistant moderate-to-severe MS relapse. Patients presenting with an MS relapse of less than 2 months without improvement and 15 days after a course of steroids were randomized. Specific criteria were used for each relapse type to define moderate-to-severe disability. The primary endpoint was the proportion of patients with at least a moderate improvement based on objective and functional evaluation after 1 month. Thirty-eight patients were randomized. The intention-to-treat analysis included 14 patients in the TPE group and 17 in the Sham-TPE group. The proportion of patients with at least moderate improvement at 1 month did not differ between the groups (P = .72), although 57.1% of the TPE group had full recovery compared with 17.6% of the sham group. Considering optic neuritis (ON), a significant difference in the proportion of different levels of improvement was observed in favor of the TPE group (P = .04). The combined Kurtzke's functional systems scores were significantly more improved in the TPE group than in the sham-TPE group at months 1 (P < .01), 3 (P < .05), and 6 (P < .05). No major side effects were observed. A significant difference between TPE and Sham-TPE at the primary endpoint was only observed in patients with ON. Neurological function improved significantly more often in the TPE group than in the sham-TPE group. © 2020 Wiley Periodicals, Inc.

Citation

Bruno Brochet, Mathilde Deloire, Christine Germain, Jean-Christophe Ouallet, Linda Wittkop, Cécile Dulau, Paul Perez, Florian Thevenot, Jérome De Sèze, Hélène Zéphir, Patrick Vermersch, Sophie Pittion, Marc Debouverie, David-Axel Laplaud, Pierre Clavelou, Aurélie Ruet. Double-blind, randomized controlled trial of therapeutic plasma exchanges vs sham exchanges in moderate-to-severe relapses of multiple sclerosis. Journal of clinical apheresis. 2020 Aug;35(4):281-289

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PMID: 32369661

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