Immunoadsorption is equally effective as plasma exchange in paediatric neuroimmunological disorders - A retrospective multicentre study

Paula Cramer; Marc Nikolaus; Sebastian Loos; Jonas Denecke; Ellen Knierim; Dominik Müller; Lutz T Weber; Christina Taylan; Julia Thumfart

doi:10.1016/j.ejpn.2024.12.005

Immunoadsorption is equally effective as plasma exchange in paediatric neuroimmunological disorders - A retrospective multicentre study

Eur J Paediatr Neurol. 2024 Dec 21:54:58-63. doi: 10.1016/j.ejpn.2024.12.005. Online ahead of print.

Authors

Paula Cramer¹, Marc Nikolaus², Sebastian Loos³, Jonas Denecke⁴, Ellen Knierim⁵, Dominik Müller¹, Lutz T Weber⁶, Christina Taylan⁶, Julia Thumfart⁷

Affiliations

¹ Department of Paediatric Nephrology, Gastroenterology and Metabolic Diseases, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
² Department of Paediatric Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany; Center for Chronically Sick Children, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
³ Department of Paediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
⁴ Department of Paediatric Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
⁵ DRK Kliniken Westend, Spandauer Damm 130, 14050, Berlin, Germany.
⁶ Department of Paediatric Nephrology, University Medical Center Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
⁷ Department of Paediatric Nephrology, Gastroenterology and Metabolic Diseases, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. Electronic address: [email protected].

PMID: 39752845
DOI: 10.1016/j.ejpn.2024.12.005

Abstract

Background: Therapeutic apheresis (TA) are promising treatment option for neuroimmunological disorders. In paediatrics, the available data is limited, particularly for the use of IA. The aim of this study was to analyse the use of PE and IA in children and adolescents, with emphasis on outcome and neurological course after treatment as well as the safety of the two modalities.

Methods: Clinical data from paediatric patients with neuroimmunological disorders treated with TA in two German university children's hospitals between 2015 and 2022 were retrospectively analysed.

Results: In total, 39 patients underwent 322 sessions of TA, of which 184 were IA and 138 PE. The most common diagnosis was autoimmune encephalitis in 39 % (n = 15) of the patients. Other indications were central nervous system inflammatory demyelinating disorders in 21 % (n = 8), Guillain-Barré syndrome in 18 % (n = 7), Myelin Oligodendrocyte Glycopeptide-antibody associated syndromes in 8 % (n = 3), Myasthenia gravis in 5 % (n = 2) and other neurological disorders in 10 % (n = 4). Overall, there was an improvement in 76 % of patients (81 % with IA, 70 % with PE; p = 0.41) immediately after treatment and an improvement in 88 % of patients (90 % with IA, 85 % with PE; p = 0.63) one month after treatment. Complications occurred in 13 % of all sessions (13 % with IA and 13 % with PE; p = 1). Most complications were considered as moderate.

Conclusion: Both, IA and PE, are effective treatment options in the therapy of neuroimmunological disorders in children and adolescents, with no major differences in terms of efficiency or safety.

Keywords: Autoimmune encephalitis; Immunoadsorption (IA); Neuroimmunological disorders; Plasma exchange (PE).