Selecting a Treatment Regimen
Multiple Sclerosis (MS)
Plasmapheresis as adjunctive therapy is probably effective for management of
exacerbations in relapsing forms of MS, based on a single Class I study.
ÎÎPlasmapheresis should be considered for the adjunctive treatment of
exacerbations in relapsing forms of MS (Level B).
ÎÎFor chronic progressive or secondary progressive MS, plasmapheresis
is established as ineffective based on consistent Class I evidence.
Note: The term chronic progressive MS is no longer used, but previously included
patients are now described as having either primary progressive MS or secondary
progressive MS.
ÎÎPlasmapheresis should not be offered for chronic progressive or
secondary progressive MS (Level A).
Remark: No studies on the efficacy of plasmapheresis compared to other treatment
options in MS are available.
Dysimmune Neuropathies
One Class I study showed the efficacy of plasmapheresis in polyneuropathies
associated with immunoglobulin A (IgA) and immunoglobulin G (IgG) monoclonal
gammopathy of undetermined significance (MGUS). That study, and a Class III study,
found no significant benefit in immunoglobulin M (IgM)-associated MGUS.
ÎÎPlasmapheresis should be considered in polyneuropathy associated
with IgA and IgG MGUS (Level B).
ÎÎPlasmapheresis should NOT be considered in the treatment of
polyneuropathy associated with IgM MGUS (Level B).
Myasthenia Gravis (MG)
ÎÎBecause of the lack of randomized controlled studies with masked
outcomes, there is insufficient evidence to support or refute the
efficacy of plasmapheresis in the treatment of myasthenic crisis
(Level U) or MG prethymectomy (Level U).
Remark: Despite the fact that the use of plasmapheresis in myasthenic crisis and MG
prethymectomy receives a Level U recommendation, plasmapheresis is used at many
medical centers for these indications.
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