Plasma exchange for severe attacks

Epub ahead of printSeifert et al. Favorable response to plasma exchange in tumefactive CNS demyelination with delayed B-cell response. Mult Scler. 2011 Nov 15.

This is a case report of someone with MS-associated fulminant tumefactive demyelinating lesion (TDL) with the special feature of delayed humoral or antibody immune response. Plasma exchange* (PE) yielded significant benefit in two consecutive steroid-unresponsive relapses, while signs of a B-cell response within the central nervous system were only present 2 years later at the second relapse. Remission was achieved and sustained thereafter with natalizumab. This case indicates that PE might be a therapeutic option even when the B-cell response is not fully developed. This delay in the development of a humoral or antibody immune response may reflect the step-wise B-cell colonization of the CNS and represent an attractive therapeutic window of opportunity.

“This study suggests that plasma exchange may be more suitable for some MS’ers with severe relapses  that others. I wonder if the Lazarus effect (dramatic responses) may be linked to these observations as well?”

Related posts of interest:
31 Oct 2011
Tumefactive multiple sclerosis: an uncommon diagnostic challenge. J Chiropr Med. 2011 Mar;10(1):29-35. OBJECTIVE: A case report describes a rare presentation of MS that was initially diagnosed as a peripheral nerve 
27 Aug 2011
It typically occurs in the form of a single large demyelinating lesion that can be indistinguishable from a brain tumor (see figure below; taken from radiopaedia). You may see the term tumefactive (tumour-like) used to describe 
Additional reading: plasma exchange

5 thoughts on “Plasma exchange for severe attacks”

  1. My question has less to do with this particular topic but more to do with PPMS.The are no good drugs for PPMS, but, as you've said, you are working to fix that. In order to get these drugs to us quicker, will drugs for PPMS be classified as an 'orphan disease'? If it will, will these drugs get approval quicker than normal, and thus, arrive on the market in a shorter time-frame?

  2. I'll leave G to comment on orphan disease status.many of the drugs we aim to investigate are already licensed for human use (in other diseases) so if they work and safety profile looks good then it should be easier to get this approved for MS, we shall see.

  3. Shortly after I was diagnosed, the exacerbation I was going through at the time took a turn for the worse and I lapsed into a coma-like state. After two rounds of high-dose IV steroids failed, I was given plasma exchange and I was able to regain consciousness.According to the Wiki link, plasma exchange has been around since the 1960s. Looking at the FDA's clinical trials website, it seems that there's not a lot of interest in researching this potential treatment for MS relapses. Is this impression correct and if so, why isn't there more interest? I'd certainly like to see more research money used to investigate it.

  4. Re: "why isn't there more interest? I'd certainly like to see more research money used to investigate it."PLEX is an invasive procedure and difficult to study in double-blind studies. In addition, it is a generic procedure so there is no money to be made by "Big Pharma" by selling a drug. However, it is undergoing a mini-revival in the UK thanks to the cost of intravenous immunoglobulin in other disorders.

  5. Re: "Will drugs for PPMS be classified as an 'orphan disease'?" Not sure; if the drug is already licensed in RRMS, almost certainly no. If the drug is only being tested in PPMS and is effective I suspect the EMA and FDA will treat PPMS as an orphan disease due to the massive unmet need. There is only one way to find out and that is by testing the waters.

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