{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:40:23Z","timestamp":1789609223923,"version":"build-2803163510"},"reference-count":47,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2018,1,1]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> Up to every fourth woman with multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD) suffers a clinically relevant relapse during pregnancy. High doses of steroids bear some serious risks, especially within the first trimester of pregnancy. Immunoadsorption (IA) is an effective and more selective treatment option in disabling MS relapse than plasma exchange. Data on the use of IA during pregnancy and breastfeeding are scarce. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> In this retrospective multicenter study, we analyzed the safety and efficacy of IA treatment in acute relapses during pregnancy or breastfeeding. The primary outcome parameter - change of acute relapse-related disability after IA - was assessed using Expanded Disability Status Scale (EDSS) and visual acuity (VA) measurements for patients with optic neuritis (ON). <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> A total of 24 patients were analyzed, 23 with relapsing\u2013remitting MS, and 1 with NMOSD. Twenty patients were treated with IA during pregnancy. Four patients received IA postnatally during the breastfeeding period. Treatment was started at a mean 22.5 [standard deviation (SD) 13.9] days after onset of relapse. Patients were treated with a series of 5.8 (mean, SD 0.7) IA treatments within 7\u201310 days. Sixteen patients received IA because of steroid-refractory relapse, eight were treated without preceding steroid pulse therapy. EDSS improved clinically relevant from 3.5 [median, interquartile range (IQR) 2] before IA to 2.5 (median, IQR 1.1) after IA, p &lt; 0.001. In patients with ON, VA improved in four out of five patients. Altogether, in 83% of patients, a rapid and marked improvement of relapse-related symptoms was observed after IA with either a decrease of \u2a7e1 EDSS grade or improvement in VA \u2a7e20%. No clinically relevant side effect was reported in 138 IA treatments. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p> Tryptophan-IA was found to be effective and well tolerated in MS\/NMOSD relapses, both as an escalation option after insufficient response to steroid pulse therapy and as first-line relapse treatment during pregnancy and breastfeeding. <\/jats:p><\/jats:sec>","DOI":"10.1177\/1756286418774973","type":"journal-article","created":{"date-parts":[[2018,5,28]],"date-time":"2018-05-28T10:42:53Z","timestamp":1527504173000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":31,"title":["Tryptophan immunoadsorption during pregnancy and breastfeeding in patients with acute relapse of multiple sclerosis and neuromyelitis optica"],"prefix":"10.1177","volume":"11","author":[{"given":"Frank","family":"Hoffmann","sequence":"first","affiliation":[{"name":"Department of Neurology, Martha-Maria Hospital, Halle\/Saale, Academic, Hospital of University, Halle-Wittenberg, R\u00f6ntgenstra\u00dfe 1, D-06120 Halle (Saale), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Kraft","sequence":"additional","affiliation":[{"name":"Department of Neurology Martha-Maria Hospital, Halle\/Saale, Academic Hospital of University Halle-Wittenberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz","family":"Heigl","sequence":"additional","affiliation":[{"name":"Medical Care Center Kempten-Allg\u00e4u, Kempten, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erich","family":"Mauch","sequence":"additional","affiliation":[{"name":"Clinic for Neurology Dietenbronn, Academic Hospital of University of Ulm, Schwendi, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Koehler","sequence":"additional","affiliation":[{"name":"Marianne-Strauss-Hospital, Multiple Sclerosis Center Kempfenhausen, Berg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutz","family":"Harms","sequence":"additional","affiliation":[{"name":"Departments of Neurology Charit\u00e9 University Medicine Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"K\u00fcmpfel","sequence":"additional","affiliation":[{"name":"Institute of Clinical Neuroimmunology, University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"K\u00f6hler","sequence":"additional","affiliation":[{"name":"Clinic for Neurology and Neurological Intensive Care Medicine, Hubertusburg Hospital, Wermsdorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Ehrlich","sequence":"additional","affiliation":[{"name":"Clinic for Neurology and Neurological Intensive Care Medicine, Hubertusburg Hospital, Wermsdorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Bayas","sequence":"additional","affiliation":[{"name":"Department of Neurology, General Hospital Augsburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Weinmann-Menke","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Medical Center of the Johannes-Gutenberg University, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Beuker","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Heinz","family":"Henn","sequence":"additional","affiliation":[{"name":"Department of Neurology and Sana Clinic, Offenbach, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Ayzenberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisa","family":"Ellrichmann","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Hellwig","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinhard","family":"Klingel","sequence":"additional","affiliation":[{"name":"Apheresis Research Institute, K\u00f6ln, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordula Marie","family":"Fassbender","sequence":"additional","affiliation":[{"name":"Apheresis Research Institute, K\u00f6ln, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Fritz","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine, Martha-Maria Hospital, Halle\/Saale, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten","family":"Slowinski","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Charit\u00e9 University Medicine, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Weihprecht","sequence":"additional","affiliation":[{"name":"Department of Nephrology, General Hospital Augsburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Brand","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University of M\u00fcnster, 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