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Home arrow Environment arrow Inflammatory Disorders of the Nervous System: Pathogenesis, Immunology, and Clinical Management
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Plasma Exchange (PLEX)

PLEX has been demonstrated to be effective in CIDP in multiple studies, including the two short-term randomized placebo-controlled trials [147, 148]. In the study by

Hahn et al., PLEX was effective in 80% of the patients as indicated by improvement in grip strength, clinical disability grade, and the mean neurologic disability score, as well as summated motor potential amplitudes and conduction velocities [148]. Of those patients who responded to the plasma exchange, most improved within 4 weeks of receiving therapy with no significant difference in responsiveness between those with progressive and relapsing disease, i.e., five of seven patients with progressive course and seven of eight patients with relapsing course improved in that study. Despite good response initially, after discontinuation of therapy, about two thirds of patients will experience deterioration within several weeks [133, 148]. There are no specific guidelines for the use of PLEX in CIDP beyond 4 weeks; clinical response, timing, and degree of deterioration should be used to guide decisionmaking regarding frequency of subsequent PLEX sessions. Usually, a maintenance therapy with one PLEX session at least every 8 weeks may be needed, sometimes in addition to other immunomodulatory medications [121].

Plasma exchange administration requires a central catheter placement and about three to five sessions per treatment. Adverse effects include bleeding, infection at the site of the catheter, hypotension, anemia, and hypocalcemia due to citrate toxicity [133]. Pre-existing coagulation abnormalities, thrombocytopenia, and hemodynamic instability warrant the use of another treatment modality.

 
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