Plasma exchange for acute optic neuritis in neuromyelitis optica or neuromyelitis optica spectrum disorder: a systematic review

Key messages Aggregate current data of this systematic review is insufficient to definitively conclude whether therapeutic PLEX is effective in improving VA in cases of NMO or NMOSD. Objectives To appraise whether plasma exchange (PLEX) effectively improves visual function for acute optic neuritis (ON) in neuromyelitis optica (NMO) or neuromyelitis optica spectrum disorder (NMOSD). Methods and analysis We searched Medline, Embase, Cochrane Library, ProQuest Central, and Web of Science to identify relevant articles published between 2006 and 2020. Eligible studies were in English and evaluated visual outcomes for people with acute ON in NMO or NMOSD treated with PLEX. They also had adequate pre- and posttreatment data. Excluded were studies with 1 or 2 case reports, or incomplete data. Results Twelve studies were qualitatively synthesized (1 RCT; 1 controlled NRSI; 10 observational studies). Five before-and-after observational studies were used for quantitative synthesis. The PLEX in the 5 studies (3 to 7 cycles over 2 to 3 weeks) was performed as second-line or adjunctive therapy for acute ON in NMO/NMOSD. The qualitative synthesis revealed that visual-acuity recovery occurred between one day and 6 months after the first PLEX cycle completion. Thirty-two of 48 participants in the 5 quantitative-synthesis studies received PLEX. Relative to pre-PLEX values, visual-acuity improvements were nonsignificant at these post-PLEX time points: 1 day (SMD 0.611; 95% CI -0.620 to 1.842); 2 weeks (SMD 0.0214; 95% CI -1.250 to 1.293); 3 months (SMD 1.014; 95% CI -0.954 to 2.982); and 6 months (SMD 0.450; 95% CI -2.643 to 3.543). Conclusions There were inadequate data to determine whether PLEX effectively treats acute ON in NMO/NMOSD.

Automated summary

The current data from this systematic review are insufficient to conclude definitively whether therapeutic plasma exchange (PLEX) is effective in improving visual acuity in cases of neuromyelitis optica (NMO) or neuromyelitis optica spectrum disorder (NMOSD). The objective of this study was to evaluate whether PLEX effectively improves visual function for acute optic neuritis (ON) in NMO or NMOSD. Twelve studies were included in the analysis, but the data were inconclusive in determining the effectiveness of PLEX for treating acute ON in NMO/NMOSD.