Plasma exchange for acute optic neuritis in neuromyelitis optica or neuromyelitis optica spectrum disorder: a systematic review

Figures & data

Figure 1. Study flow diagram.

Table 1. Main characteristics of studies included in the qualitative synthesis.

References	Study Design/ Country	Mean age (years)	No of patients/Eye	F	Dose Mean /Range (cycles)	Timing from onset Mean/Range (days)	Parameters
Trebst et al. 2009 [14]	OS Germany	46	2(PLEX 2)/6	2	5/3-7	43.6/34-62	VA VEPs
Roesner et al. 2012 [15]	OS Germany	73	1(PLEX1)/2		5/NA	31/NA	VA
Merle et al. 2012 [13]	Controlled-NRSIs France	35.6	32(PLEX10)/52	29	5/NA	14-21/NA	VA, Color Contrast, VF, OCT
Koziolek et al. 2013 [16]	OS Germany	8.5	2(PLEX2)/NA	2	5/NA	38/28-48	VA EDSS
Deschamps et al. 2016 [17]	OS France	36	11(PLEX11)/15	10	5.9/5-10	14-78/29	VA OCT
Aungsumart et al. 2017 [11]	OS Thailand	41	11(PLEX11)/NA		5/NA	11/NA	VA
Mori et al. 2018 [18]	OS Japan	53	9(PLEX9)/15	8	5/3-7	24.4 /NA	VA
Song et al. 2019 [4]	OS China	36.13	31(PLEX15)/NA	28	4/2-3	14/NA	VA, VF VEPs
Yamagami et al. 2019 [3]	OS Japan	49.9	69(PLEX14)/103	62			VA
Lipphardt et al. 2019 [19]	OS Germany	51.5	12(PLEX11, IA 1)/NA	10	5-7/NA	23.8/NA	VA EDSS
Savransky et al. 2019 [20]	OS Argentina	10.5	47(PLEX47)/NA		6/NA	23/3-186	VA EDSS
Songthammawat et al. 2020 [12]	RCT Thailand	37.9	6(PLEX6)/NA	6	5/NA	10.5/NA	VA EDSS

EDSS: expanded disability status scale; F: female; IA: immunoadsorption; IVIG: intravenous immunoglobulin; IVMP: intravenous methylprednisolone; MS: multiple sclerosis; NA: not available; NMO: neuromyelitis optica; NMOSD: neuromyelitis optical spectrum disorder; OS: observational study; PE: plasma exchange; PLEX: plasma exchange; NRSIs: non-randomized studies of interventions; RNFL: retinal nerve fiber layer; VA: visual acuity; VEPs: visual evoked potentials.

Table 2. Details of visual acuity (VA) before and after plasma exchange (PLEX) of studies included in the quantitative synthesis.

References	No. of patients	Parameter	Before PLEX	After PLEX and timing
				1 day	2 weeks	1 month	3 months	6 months
Trebst et al. 2009 [14]	Case 1	VA (LogMAR)	0.699	0.398	–	–	–	–
	Case 2		0.0969	0.0969	–	–	–	–
	Case 3		0.602	0.398	–	–	–	–
	Case 4		0.237	0.155	–	–	–	–
	Case 5		1.3	–	–	–	1.0	–
	Case 6		0.3	–	–	–	0.07	–
Roesner et al. 2012 [15]	Case 1	VA (LogMAR)	1.3	–	1.0	0.125	–	–
	Case 2		1.3	–	0699	0.30	–	–
Koziolek et al. 2013 [16]	Case 1	VA (LogMAR)	1.602	0.699	–	–	0.3	0.097
	Case 2		0.699	0.222	–	–	0.046	0
	Case 3		0.796	1.0	–	–	0.222	0
Song et al. 2019 [4]	15	Mean VA (LogMAR)	1.78 ± 0.83	–	1.26 ± 0.66	–	–	–
Lipphardt et al. 2019 [19]	12	Mean VA (decimal score/LogMAR)	0.23 ± 0.24/Log 0.638	–	0.44 ± 0.32/Log 0.357	–	–	0.52 ± 0.43/Log 0.284

Figure 2. Forest plots of simple meta-analysis of post-plasma Exchanges at 1 day (A), 2 weeks (B), 3 months (C), and 6 months (D).

Figure 3. Cochrane’s assessment tools for observational studies.

Table 3. Overall risk of bias of studies included in the meta-analysis.

References	Study design	Assessment tools	Overall risk of bias
Trebst et al. 2009 [14]	Before-and-after studies	Cochrane’s tools	High
Roesner et al. 2012 [15]	Before-and-after studies	Cochrane’s tools	High
Koziolek et al. 2013 [16]	Before-and-after studies	Cochrane’s tools	Low
Song et al. 2019 [4]	Before-and-after studies	Cochrane’s tools	Low
Lipphardt et al. 2019 [19]	Before-and-after studies	Cochrane’s tools	Low

Figure 4. Risk of bias 2.0 (ROB2) assessment for randomized controlled trial.

Figure 5. ROBINS-I tools for controlled non-randomized studies of intervention.

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Songthammawat T, Srisupa-Olan T, Siritho S, et al. A pilot study comparing treatments for severe attacks of neuromyelitis optica spectrum disorders: intravenous methylprednisolone (IVMP) with add-on plasma exchange (PLEX) versus simultaneous ivmp and PLEX. Mult Scler Relat Disord. 2020;38:101506. doi: 10.1016/j.msard.2019.101506.

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Data availability statement

The datasets generated or analyzed during the study are included in this published article and its supplementary information files. All background or extracted data are available from the corresponding author upon reasonable request.