Should Apheresis Be Used First- or Second-Line in Neuromyelitis Optica?

Treatment of acute exacerbations of neuromyelitis optica (NMO) typically consists of intravenous methylprednisolone, apheresis therapy (plasmapheresis or immunoadsorption), or a combination. No consensus exists on the urgency and order of these therapies. To evaluate the effectiveness of apheresis therapies, investigators retrospectively analyzed data on 105 patients with 207 exacerbations from the German NMO Study Group cohort.

Among 230 procedures performed, apheresis was used as first-line therapy in 31%, second-line in 44%, and third-line or later in 25%. Median time from onset to start of therapy was 1 day for first-line therapy, 11.5 days for second-line, and 15.5 days for third-line or later. Patients with apheresis begun in the first…