Meta-analysis of clinical studies of the efficacy of plasma exchange in the treatment of chronic progressive multiple sclerosis.

Abstract

OBJECTIVE:

To examine the hypothesis that addition of therapeutic plasma exchange (TPEX) to an immunosuppressive drug regimen increases that regimen's efficacy to halt the progression of chronic progressive multiple sclerosis (CPMS).

METHODS:

The literature was searched for prospective controlled clinical trials evaluating the efficacy of TPEX in CPMS. Six studies were eligible for meta-analysis. Their results were combined, using Cochran's and Peto's methods. Three outcome measures were studied: 1) the change in Kurtzke's disability status scale (DSS) scores, 2) the relative odds of neurologic decline by 1 or more DSS grades, and 3) the relative odds of neurologic improvement by 1 or more DSS grades, in the treatment versus the comparison group of patients. Reported results of neurologic evaluations at 6, 12, 24, and 36 months of follow-up were analyzed separately.

RESULTS:

TPEX significantly (P < .05) reduced the proportion of patients who experienced neurologic decline (by 1 or more DSS grades) at 12 months of follow-up (relative odds of decline = 0.441, 95% confidence interval = 0.210-0.929).

CONCLUSIONS:

There is a need for further clinical research into the possibility of a beneficial effect of TPEX in patients with CPMS likely to experience neurologic decline over the ensuring 12 months. Targeting treatment to a particular subgroup of CPMS patients may be necessary for TPEX to prove effective.

• Authors: E C Vamvakas, A A Pineda, B G Weinshenker
• Journal: Journal of clinical apheresis (J Clin Apher) Vol. 10 Issue 4 Pg. 163-70 ( 1995) ISSN: 0733-2459 [Print] United States
• PMID: 8770707 (Publication Type: Journal Article, Meta-Analysis)

Topics

• Chronic Disease
• Disease Progression
• Humans
• Multiple Sclerosis (pathology, therapy)
• Odds Ratio
• Plasma Exchange
• Prospective Studies
• Randomized Controlled Trials as Topic
• Treatment Outcome