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Plasmapheresis is a safe and effective treatment option for elderly patients with neuromyelitis optica spectrum disorder during attacks.

NMOSD is an autoimmune disorder that causes cycles of escalating relapse. With an increasing rate of diagnosis in the elderly, therapeutic decision-making becomes more challenging due to multiple comorbidities and the high risk of drug-induced side effects. Plasma exchange (PLEX), which is also called plasmapheresis, is a well-known method of treating a variety of neuroimmunological conditions. It works by removing the patient’s plasma and replacing it with a fluid that removes harmful inflammatory substances like AQP4-IgG, antibodies, and pro-inflammatory cytokines. People with NMOSD have been helped by PLEX, which can be used as a first-line treatment or a way to help during attacks. This retrospective study, published in the journal Therapeutic Advances in Neurological Disorders, assessed the efficacy and safety of standard PLEX treatment in an elderly population with NMOSD.

Age and Comorbidities in Elderly Patients With NMOSD

At the time of the first procedures, 76 patients with NMOSD who got PLEX were divided into two groups based on their age: either elderly (less than 60 years, n = 26) or young (more than 60 years).The mean age of the 26 elderly patients was 67.7 ± 7.9 years (range 60–87 years), and the population was predominantly female (88.5%). The elderly had significantly more comorbidities and concomitant medications compared with the young.

Functional Improvement After PLEX in Elderly Patients

Functional improvement was defined as any reduction in the Expanded Disability Status Scale (EDSS) or Visual Outcome Scale (VOS) score. One month after the last session of PLEX, 88.0% of patients in the elderly group showed functional improvement, which increased to 96.0% at the 6-month follow-up. In patients initially treated with intravenous methylprednisolone and intravenous immunoglobulin (IVMP/IVIg), the reduction in EDSS score following PLEX was considerably greater than after IVMP/IVIg therapy at 1 and 6 months.

Age and Optic Neuritis Severity

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A severe ocular neuritis episode was a significant independent prognostic risk linked with a poor PLEX response, as determined by logistic regression. Imaging revealed significantly fewer cervical spinal lesions in elderly patients (4.8%) compared with the young (26.3%). The groups were the same regarding overall or serious side effects. The rate of transient hypotension was significantly higher in the elderly than in the young.

This study found that PLEX is a safe and effective therapy for elderly patients with NMOSD, but caution should be taken to prevent hypotension. PLEX may be a useful second-line treatment for NMOSD patients who are unresponsive to first-line therapy, particularly if they have had severe optic neuritis attacks. The study emphasizes the importance of considering age-related factors and comorbidities when developing treatment approaches for NMOSD.


Zhang, W., Jiao, Y., Cui, L., Zhang, Y., Jiao, J., Jin, M., Yuan, W., You, Y., Wang, R., & Peng, D. (2023). Therapeutic efficacy and safety of plasmapheresis in elderly patients with neuromyelitis optica spectrum disorder: a single-center observational study. Therapeutic Advances in Neurological Disorders, 16, 17562864231162420. https://doi.org/10.1177/17562864231162420