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.
ÎPlasmapheresis should be considered for the adjunctive treatment of exacerbations in relapsing forms of MS (Level B).
ÎFor 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.
ÎPlasmapheresis 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.
ÎPlasmapheresis should be considered in polyneuropathy associated with IgA and IgG MGUS (Level B).
ÎPlasmapheresis should NOT be considered in the treatment of polyneuropathy associated with IgM MGUS (Level B).
Myasthenia Gravis (MG)
ÎBecause 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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