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Center for Neurologic Diseases, Division of Neurology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (Dr. Weiner)
Evanston Hospital, Division of Allergy/Immunology, Department of Neurology, Northwestern University Medical School, Chicago, IL (Dr. Dau)
Department of Neurology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, WI (Dr. Khatri)
Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT (Dr. Petajan)
Department of Neurology, University of Minnesota Hospital, Minneapolis, MN (Dr. Birnbaum)
Department of Neurology, University of Kentucky, Lexington, KY (Dr. McQuillen)
Blood Bank, Children's Hospital, Boston, MA (Dr. Fosburg)
Department of Biostatistics, Harvard School of Public Health, Boston, MA (Drs. Feldstein and Orav)
We enrolled 116 patients in a multicenter, randomized, double-blind controlled trial of an 8-week course of 11 plasma exchange (PE) treatments in exacerbations of MS. The control group received sham PE, and both groups received identical treatment with IM ACTH and oral cyclophosphamide. Serum IgG decreased in the PE and sham treatment groups by 76% versus 22% by treatment 5, and by 64% versus 14% by treatment 11. PE also produced significant reductions in IgA, IgM, C3, and fibrinogen. PE patients had moderately enhanced improvement at 2 weeks relative to the sham group. PE patients with relapsing/remitting disease had significantly enhanced improvement at 4 weeks and there was also an increased improvement at 12 months, although this latter effect disappeared when we analyzed relapsing/remitting patients as a separate subgroup. Life table analysis showed the median time to recover preattack disability status was shorter in PE- than in sham-treated relapsing/remitting patients (4 vs. 13 weeks), a result confirmed by raw disability status scores in which there was recovery to their average preattack disability score by 3 months. PE given with ACTH plus cyclophosphamide enhances recovery from an exacerbation of disease in relapsing/remitting patients, although we observed no clear long-term benefits.
Address correspondence and reprint requests to Dr. Weiner, Multiple Sclerosis Unit, Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA 02115.
Supported by NIH grant #18358 from the NINCDS. The National Multiple Sclerosis Society sponsored organizational meetings that led to the present study.
Presented in part at the fortieth annual meeting of the American Academy of Neurology, Cincinnati, OH, April 1988.
Received January 27, 1989. Accepted for publication in final form May 24, 1989.
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