Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange

Mult Scler. 2016 Feb;22(2):185-92. doi: 10.1177/1352458515581438. Epub 2015 Apr 28.


Background: Although adding plasma exchange (PLEX) to steroids in severe neuromyelitis optica (NMO) attacks is common practice in steroid-resistant cases, the benefit of this strategy has not been previously quantified.

Objective: The objective of this paper is to compare the efficacy of high-dose intravenous methylprednisolone (IVMP) versus IVMP+PLEX in treatment of acute NMO relapses.

Methods: We conducted a retrospective review of the last 83 NMO admissions to the Johns Hopkins Hospital treated with IVMP alone versus IVMP+PLEX (for steroid-resistant cases). Extended Disability Status Scale (EDSS) score was calculated at baseline, at presentation, at discharge, and on follow-up.

Results: Eighteen NMO relapses (16 patients, 87% female, mean age at relapse: 33.9±23.8, median baseline EDSS 2.5) were treated with IVMP alone and 65 relapses (43 patients, 95% female, mean age at relapse: 43.8±15.7, median baseline EDSS 5.75) were treated with IVMP + PLEX. Sixty-five percent of IVMP + PLEX patients achieved an EDSS equal or below their baseline at follow-up while only 35% of the IVMP-only patients achieved their baseline EDSS on follow-up (odds ratio=3.36, 95% CI 1.0657 to 10.6004, p = 0.0386). PLEX was more effective in improving EDSS in patients on preventive immunosuppressive medications at time of relapse.

Conclusions: PLEX+IVMP are more likely to improve EDSS after NMO relapses compared to IVMP alone, especially in patients taking preventive medications.

Keywords: EDSS; Neuromyelitis optica; acute relapse; plasma exchange; preventive medications; steroids.

MeSH terms

  • Acute Disease
  • Administration, Intravenous
  • Adult
  • Cohort Studies
  • Combined Modality Therapy
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Neuromyelitis Optica / therapy*
  • Plasma Exchange / methods*
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult


  • Glucocorticoids
  • Methylprednisolone