gms | German Medical Science

Joint-Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN) and the Scandinavian Neuropathological Society (SNS)

Deutsche Gesellschaft für Neuropathologie und Neuroanatomie

22.09.-24.09.2016, Hamburg

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Apheresis therapy in multiple sclerosis patients with histopathologically classified immunopathological patterns

Meeting Abstract

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  • presenting/speaker Lidia Stork - Univetsity Medical Center Göttingen, Institute of Neuropathology, Göttingen, Germany
  • David Ellenberger - University Medical Center Göttingen, Department of Medical Statistics, Göttingen, Germany
  • Tim Beißbarth - University Medical Center Göttingen, Department of Medical Statistics, Göttingen, Germany
  • Tim Friede - University Medical Center Göttingen, Department of Medical Statistics, Göttingen, Germany
  • Claudia Lucchinetti - Mayo Clinic, Department of Neurology, Rochester, United States
  • Wolfgang Brück - Univetsity Medical Center Göttingen, Institute of Neuropathology, Göttingen, Germany
  • Imke Metz - Univetsity Medical Center Göttingen, Institute of Neuropathology, Göttingen, Germany

Deutsche Gesellschaft für Neuropathologie und Neuroanatomie. Scandinavian Neuropathological Society. Joint-Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN) and the Scandinavian Neuropathological Society (SNS). Hamburg, 22.-24.09.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dgnnNI2

doi: 10.3205/16dgnn11, urn:nbn:de:0183-16dgnn119

Veröffentlicht: 14. September 2016

© 2016 Stork et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Apheresis therapies include plasma exchange (PLEX) and immunoadsorption (IA), second line therapies to treat steroid unresponsive multiple sclerosis (MS) relapses that show a comparable response rate of 40 - 90%. Early active MS lesions can be classified into three main, intraindividually stable immunopathological patterns of demyelination (IP I-III), which suggests pathogenic heterogeneity and may also predict therapy response to PLEX/IA. A prior study of 19 patients showed that patients with an IP II, characterized by immunoglobulin and complement deposition, responded to PLEX treatment in contrast to patients with IPs I and III who had no treatment effects.

We aimed to evaluate the PLEX/IA response for MS relapses in relation to histopathologically defined IPs in a larger cohort of patients.

For this we retrospectively analyzed the efficacy of PLEX/IA in patients with early active demyelinating MS lesions histologicaly classified into IPs I-III. Primary outcome was a functional improvement of the neurological deficit occurring with the relapse. MRI and expanded disability status scale (EDSS) changes were used as secondary outcome parameters.

Clinical records of 69 patients were assessed. The highest response rate to PLEX/IA was 55% (22/40 patients) observed among IP II patients compared to no improvement found in patients with IP III (0/13; p

We confirmed that the therapy response to apheresis treatment is related to histopathologically defined IPs. Importantly, patients with both patterns I and II improved clinically after apheresis treatment; however, those patients with signs of a humoral immune response profited most from therapy. No clinical improvement was observed in patients with an IP III.