{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:05:09Z","timestamp":1791389109971,"version":"4.3.3"},"reference-count":29,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2019,12,22]],"date-time":"2019-12-22T00:00:00Z","timestamp":1576972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Intravenous methyl prednisolone (IVMPS) represents the standard of care for multiple sclerosis (MS) relapses, but fail to improve symptoms in one quarter of patients. In this regard, apart from extending steroid treatment to a higher dose, therapeutic plasma exchange (TPE) has been recognized as a treatment option. The aim of this retrospective, monocentric study was to investigate the efficacy of TPE versus escalated dosages of IVMPS in refractory MS relapses. An in-depth medical chart review was performed to identify patients from local databases. Relapse recovery was stratified as \u201cgood\/full\u201d, \u201caverage\u201d and \u201cworst\/no\u201d according to function score development. In total, 145 patients were analyzed. Good\/average\/worst recovery at discharge was observed in 60.9%\/32.6%\/6.5% of TPE versus 15.2%\/14.1%\/70.7% of IVMPS patients, respectively. A total of 53.5% of IVMPS patients received TPE as rescue treatment and 54.8% then responded satisfactorily. The multivariable odds ratio (OR) for worst\/no recovery was 39.01 (95%\u2013CI: 10.41\u2013146.18; p \u2264 0.001), favoring administration of TPE as first escalation treatment. The effects were sustained at three-month follow-ups, as OR for further deterioration was 6.48 (95%\u2013CI: 2.48\u201316.89; p \u2264 0.001), favoring TPE. In conclusion, TPE was superior over IVMPS in the amelioration of relapse symptoms at discharge and follow-up. This study provides class IV evidence supporting the administration of TPE as the first escalation treatment to steroid-refractory MS relapses.<\/jats:p>","DOI":"10.3390\/jcm9010035","type":"journal-article","created":{"date-parts":[[2019,12,23]],"date-time":"2019-12-23T03:23:12Z","timestamp":1577071392000},"page":"35","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Comparing Plasma Exchange to Escalated Methyl Prednisolone in Refractory Multiple Sclerosis Relapses"],"prefix":"10.3390","volume":"9","author":[{"given":"Steffen","family":"Pfeuffer","sequence":"first","affiliation":[{"name":"Neurology Clinic and Institute for Translational Neurology, University of Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leoni","family":"Rolfes","sequence":"additional","affiliation":[{"name":"Neurology Clinic and Institute for Translational Neurology, University of Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eike","family":"Bormann","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Clinical Research, University of Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Sauerland","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Clinical Research, University of Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Ruck","sequence":"additional","affiliation":[{"name":"Neurology Clinic and Institute for Translational Neurology, University of Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Schilling","sequence":"additional","affiliation":[{"name":"Neurology Clinic and Institute for Translational Neurology, University of Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nico","family":"Melzer","sequence":"additional","affiliation":[{"name":"Neurology Clinic and Institute for Translational Neurology, University of Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Brand","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine D, University of Muenster 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Refik","family":"Pul","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Kleinschnitz","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz","family":"Wiendl","sequence":"additional","affiliation":[{"name":"Neurology Clinic and Institute for Translational Neurology, University of Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven G.","family":"Meuth","sequence":"additional","affiliation":[{"name":"Neurology Clinic and Institute for Translational Neurology, University of Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,12,22]]},"reference":[{"key":"ref_1","unstructured":"National Institute for Health and Care Excellence (2019, December 03). 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