From the Research
Plasma exchange (plasmapheresis) is not typically indicated as a first-line treatment for multiple sclerosis (MS) with vision loss, but may be considered as a second-line therapy for patients with severe MS relapses who do not respond adequately to corticosteroid treatment. The standard first-line treatment for acute MS relapses, including optic neuritis causing vision loss, is high-dose intravenous methylprednisolone (typically 1000 mg daily for 3-5 days) 1. If a patient shows minimal or no improvement after 7-10 days of steroid therapy, plasma exchange may be considered, typically administered as 5-7 exchanges over 1-2 weeks.
Key Points to Consider
- The rationale behind plasma exchange is the removal of circulating antibodies, immune complexes, and inflammatory mediators that contribute to the demyelination process in MS 2.
- Plasma exchange works by separating plasma from blood cells, removing harmful substances, and returning the blood cells with replacement fluid to the patient.
- While plasma exchange can be effective in some cases, it carries risks including infection, bleeding complications, and hemodynamic instability, which must be weighed against potential benefits 3.
- A recent study found that plasma exchange can be considered as a safe second-line therapy in MS relapses, with hypotension, skin reaction, hemoglobin loss, and hypokalemia being the most common complications 3.
Important Considerations
- The decision to use plasma exchange should be made on a case-by-case basis, taking into account the individual patient's response to corticosteroid treatment and the severity of their MS relapse.
- Patients with severe MS relapses who do not respond to corticosteroid treatment may benefit from plasma exchange, but the treatment should be carefully monitored for potential complications.
- The use of plasma exchange as a second-line therapy for MS relapses is supported by recent studies, including a 2023 study that found it to be a safe and effective treatment option 3.