{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:47:26Z","timestamp":1783352846676,"version":"3.54.6"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100003030","name":"AGAUR","doi-asserted-by":"crossref","award":["021-SGR-01325"],"award-info":[{"award-number":["021-SGR-01325"]}],"id":[{"id":"10.13039\/501100003030","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100017642","name":"Spanish National Plan for Scientific and Technical Research and Innovation","doi-asserted-by":"publisher","award":["PI21\/00828"],"award-info":[{"award-number":["PI21\/00828"]}],"id":[{"id":"10.13039\/501100017642","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017642","name":"Spanish National Plan for Scientific and Technical Research and Innovation","doi-asserted-by":"publisher","award":["PI21\/01189"],"award-info":[{"award-number":["PI21\/01189"]}],"id":[{"id":"10.13039\/501100017642","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017642","name":"Spanish National Plan for Scientific and Technical Research and Innovation","doi-asserted-by":"publisher","award":["PI24\/00567"],"award-info":[{"award-number":["PI24\/00567"]}],"id":[{"id":"10.13039\/501100017642","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017642","name":"Spanish National Plan for Scientific and Technical Research and Innovation","doi-asserted-by":"publisher","award":["PI24\/01018"],"award-info":[{"award-number":["PI24\/01018"]}],"id":[{"id":"10.13039\/501100017642","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Red Espa\u00f1ola de Enfermedades Inflamatorias","award":["RD24\/0007\/0013"],"award-info":[{"award-number":["RD24\/0007\/0013"]}]},{"name":"Red Espa\u00f1ola de Enfermedades Inflamatorias","award":["RD24\/0007\/0034"],"award-info":[{"award-number":["RD24\/0007\/0034"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Plasma exchange (PE) is a therapeutic option for CNS demyelinating attacks unresponsive to corticosteroids, but the potential benefit of adding rituximab and IV immunoglobulins to PE (RTX-IVIG-PE), which has shown its efficacy and safety in other immune-mediated conditions, has not been investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>We aimed to determine the overall effectiveness of PE in severe demyelinating attacks, identify predictors of response, and compare outcomes between standard PE and RTX-IVIG-PE protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective analysis of patients with CNS demyelinating attacks treated with PE between 2012 and 2023 across five Spanish hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Clinical response was measured as an improvement or a complete recovery at discharge and 6\u2009months. Uni- and multivariable logistic regression models were developed to identify predictors of PE response. A logistic regression analysis, after inverse probability of treatment weighting (IPTW), was performed to compare the outcome of attacks treated with standard PE and RTX-IVIG-PE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 162 attacks in 150 patients (81 multiple sclerosis; 37 others acquired demyelinating syndromes; 27 neuromyelitis optica spectrum disorder; 5 myelin oligodendrocyte glycoprotein antibody-associated disease; 73% female; median age 43\u2009years (interquartile range 33\u201352.75)) were analyzed. At discharge, 60% of all attacks showed clinical improvement, and 15% achieved complete recovery. At 6\u2009months, these rates increased to 77% and 31%, respectively. Younger age, lower preattack Expanded Disability Status Scale, and treatment with RTX-IVIG-PE were independent predictors of complete recovery at 6\u2009months. IPTW analysis showed that attacks treated with RTX-IVIG-PE (33) were associated with improvement (adjusted odds ratio (aOR) 5.4,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and complete recovery (aOR 4.55,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001) at 6\u2009months compared to those treated with standard PE (129), without significant differences in the adverse event profile between the two protocols.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>PE improves the outcome of steroid-refractory CNS demyelinating attacks, and the addition of rituximab and IVIG to PE may increase the likelihood of long-term recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562864261440665","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T02:31:32Z","timestamp":1778207492000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Rituximab and IVIG added to plasma exchange improves the outcome of severe CNS demyelinating attacks: a retrospective study"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6557-912X","authenticated-orcid":false,"given":"Juan Luis","family":"Chico-Garcia","sequence":"first","affiliation":[{"name":"Neurology Department, Hospital Universitario Ram\u00f3n y Cajal, Ctra. Colmenar Km. 9.100, 28034 Madrid, Spain"},{"name":"Multiple Sclerosis CSUR Unit, Ramon y Cajal University Hospital, Madrid, Spain, Foundation for Biomedical Research of University Hospital Ram\u00f3n y Cajal, Madrid, Spain, Alcala University, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9184-529X","authenticated-orcid":false,"given":"Mois\u00e9s","family":"Morales de la Prida","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit, Neurology Department, \u201cVirgen de la Arrixaca\u201d Clinical University Hospital, IMIB-Arrixaca, Murcia, Spain"},{"name":"Clinical Neuroimmunology and Multiple Sclerosis (NICEM) Cathedra, UCAM, San Antonio Catholic University, Murcia, Spain"},{"name":"Department of Neurology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almudena","family":"Boix Lago","sequence":"additional","affiliation":[{"name":"Neurodegeneration and Neuroinflammation Group Unitat de Neuroimmunologia i Esclerosi M\u00faltiple Territorial Girona, Departamento de Neurologia, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Manuel","family":"Garc\u00eda-Dom\u00ednguez","sequence":"additional","affiliation":[{"name":"MS Unit, Neurology Department, Hospital Universitario Gregorio Mara\u00f1\u00f3n, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3078-645X","authenticated-orcid":false,"given":"Mar\u00eda","family":"Sep\u00falveda","sequence":"additional","affiliation":[{"name":"Neuroimmunology and MS Unit, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of 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