A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease

Brian G Weinshenker, Peter C. O'Brien, Tanya M. Petterson, John H. Noseworthy, Claudia F Lucchinetti, David William Dodick, Alvaro A. Pineda, Lorna N. Stevens, Moses Rodriguez

Research output: Contribution to journalArticle

616 Citations (Scopus)

Abstract

There are no established treatments for patients with acute, severe neurological deficits caused by multiple sclerosis or other inflammatory demyelinating diseases of the central nervous system who fail to recover after treatment with high-dose corticosteroids. We conducted a randomized, sham-controlled, double-masked study of plasma exchange without concomitant immunosuppressive treatment in patients with recently acquired, severe neurological deficits resulting from attacks of inflammatory demyelinating disease, who failed to recover after treatment with intravenous corticosteroids. Patients who did not achieve moderate or greater improvement after the first treatment phase crossed over to the opposite treatment. Moderate or greater improvement in neurological disability occurred during 8 of 19 (42.1%) courses of active treatment compared with 1 of 17 (5.9%) courses of sham treatment. The primary analysis was positive. Improvement occurred early in the course of treatment, and was sustained on follow-up. However, 4 of the patients who responded to the active treatment experienced new attacks of demyelinating disease during 6 months of follow-up. Moderate or greater improvement occurred during follow-up in only 2 of 13 patients who failed to improve during the treatment phase. Plasma exchange leads to functionally important neurological recovery in an important proportion of severely disabled patients with acute attacks of idiopathic inflammatory demyelinating disease.

Original languageEnglish (US)
Pages (from-to)878-886
Number of pages9
JournalAnnals of Neurology
Volume46
Issue number6
DOIs
StatePublished - 1999

Fingerprint

Plasma Exchange
Demyelinating Diseases
Central Nervous System
Therapeutics
Adrenal Cortex Hormones
Immunosuppressive Agents
Double-Blind Method
Multiple Sclerosis
Placebos

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. / Weinshenker, Brian G; O'Brien, Peter C.; Petterson, Tanya M.; Noseworthy, John H.; Lucchinetti, Claudia F; Dodick, David William; Pineda, Alvaro A.; Stevens, Lorna N.; Rodriguez, Moses.

In: Annals of Neurology, Vol. 46, No. 6, 1999, p. 878-886.

Research output: Contribution to journalArticle

Weinshenker, Brian G ; O'Brien, Peter C. ; Petterson, Tanya M. ; Noseworthy, John H. ; Lucchinetti, Claudia F ; Dodick, David William ; Pineda, Alvaro A. ; Stevens, Lorna N. ; Rodriguez, Moses. / A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. In: Annals of Neurology. 1999 ; Vol. 46, No. 6. pp. 878-886.
@article{5078a320f545439fa1b8b7e7de074799,
title = "A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease",
abstract = "There are no established treatments for patients with acute, severe neurological deficits caused by multiple sclerosis or other inflammatory demyelinating diseases of the central nervous system who fail to recover after treatment with high-dose corticosteroids. We conducted a randomized, sham-controlled, double-masked study of plasma exchange without concomitant immunosuppressive treatment in patients with recently acquired, severe neurological deficits resulting from attacks of inflammatory demyelinating disease, who failed to recover after treatment with intravenous corticosteroids. Patients who did not achieve moderate or greater improvement after the first treatment phase crossed over to the opposite treatment. Moderate or greater improvement in neurological disability occurred during 8 of 19 (42.1{\%}) courses of active treatment compared with 1 of 17 (5.9{\%}) courses of sham treatment. The primary analysis was positive. Improvement occurred early in the course of treatment, and was sustained on follow-up. However, 4 of the patients who responded to the active treatment experienced new attacks of demyelinating disease during 6 months of follow-up. Moderate or greater improvement occurred during follow-up in only 2 of 13 patients who failed to improve during the treatment phase. Plasma exchange leads to functionally important neurological recovery in an important proportion of severely disabled patients with acute attacks of idiopathic inflammatory demyelinating disease.",
author = "Weinshenker, {Brian G} and O'Brien, {Peter C.} and Petterson, {Tanya M.} and Noseworthy, {John H.} and Lucchinetti, {Claudia F} and Dodick, {David William} and Pineda, {Alvaro A.} and Stevens, {Lorna N.} and Moses Rodriguez",
year = "1999",
doi = "10.1002/1531-8249(199912)46:6<878::AID-ANA10>3.0.CO;2-Q",
language = "English (US)",
volume = "46",
pages = "878--886",
journal = "Annals of Neurology",
issn = "0364-5134",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease

AU - Weinshenker, Brian G

AU - O'Brien, Peter C.

AU - Petterson, Tanya M.

AU - Noseworthy, John H.

AU - Lucchinetti, Claudia F

AU - Dodick, David William

AU - Pineda, Alvaro A.

AU - Stevens, Lorna N.

AU - Rodriguez, Moses

PY - 1999

Y1 - 1999

N2 - There are no established treatments for patients with acute, severe neurological deficits caused by multiple sclerosis or other inflammatory demyelinating diseases of the central nervous system who fail to recover after treatment with high-dose corticosteroids. We conducted a randomized, sham-controlled, double-masked study of plasma exchange without concomitant immunosuppressive treatment in patients with recently acquired, severe neurological deficits resulting from attacks of inflammatory demyelinating disease, who failed to recover after treatment with intravenous corticosteroids. Patients who did not achieve moderate or greater improvement after the first treatment phase crossed over to the opposite treatment. Moderate or greater improvement in neurological disability occurred during 8 of 19 (42.1%) courses of active treatment compared with 1 of 17 (5.9%) courses of sham treatment. The primary analysis was positive. Improvement occurred early in the course of treatment, and was sustained on follow-up. However, 4 of the patients who responded to the active treatment experienced new attacks of demyelinating disease during 6 months of follow-up. Moderate or greater improvement occurred during follow-up in only 2 of 13 patients who failed to improve during the treatment phase. Plasma exchange leads to functionally important neurological recovery in an important proportion of severely disabled patients with acute attacks of idiopathic inflammatory demyelinating disease.

AB - There are no established treatments for patients with acute, severe neurological deficits caused by multiple sclerosis or other inflammatory demyelinating diseases of the central nervous system who fail to recover after treatment with high-dose corticosteroids. We conducted a randomized, sham-controlled, double-masked study of plasma exchange without concomitant immunosuppressive treatment in patients with recently acquired, severe neurological deficits resulting from attacks of inflammatory demyelinating disease, who failed to recover after treatment with intravenous corticosteroids. Patients who did not achieve moderate or greater improvement after the first treatment phase crossed over to the opposite treatment. Moderate or greater improvement in neurological disability occurred during 8 of 19 (42.1%) courses of active treatment compared with 1 of 17 (5.9%) courses of sham treatment. The primary analysis was positive. Improvement occurred early in the course of treatment, and was sustained on follow-up. However, 4 of the patients who responded to the active treatment experienced new attacks of demyelinating disease during 6 months of follow-up. Moderate or greater improvement occurred during follow-up in only 2 of 13 patients who failed to improve during the treatment phase. Plasma exchange leads to functionally important neurological recovery in an important proportion of severely disabled patients with acute attacks of idiopathic inflammatory demyelinating disease.

UR - http://www.scopus.com/inward/record.url?scp=0032758846&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032758846&partnerID=8YFLogxK

U2 - 10.1002/1531-8249(199912)46:6<878::AID-ANA10>3.0.CO;2-Q

DO - 10.1002/1531-8249(199912)46:6<878::AID-ANA10>3.0.CO;2-Q

M3 - Article

C2 - 10589540

AN - SCOPUS:0032758846

VL - 46

SP - 878

EP - 886

JO - Annals of Neurology

JF - Annals of Neurology

SN - 0364-5134

IS - 6

ER -