TY - JOUR
T1 - Meta‐analysis of clinical studies of the efficacy of plasma exchange in the treatment of chronic progressive multiple sclerosis
AU - Vamvakas, Eleftherios C.
AU - Pineda, Alvaro A.
AU - Weinshenker, Brian G.
PY - 1995
Y1 - 1995
N2 - 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 lt; .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.
AB - 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 lt; .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.
KW - course
KW - disability status scale
KW - meta‐analysis
KW - multiple sclerosis
KW - plasmapheresis
KW - progression
KW - therapeutic plasma exchange
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U2 - 10.1002/jca.2920100402
DO - 10.1002/jca.2920100402
M3 - Article
C2 - 8770707
AN - SCOPUS:0029619264
SN - 0733-2459
VL - 10
SP - 163
EP - 170
JO - Journal of Clinical Apheresis
JF - Journal of Clinical Apheresis
IS - 4
ER -