Plasma Exchange In The Treatment Of Multiple Sclerosis: A System Review

Objectives:To assess the RCTs about the effectiveness of plasma exchange in the treatment of multiple sclerosis.Methods: First,We searched The Cochrane Library, PubMed, VIP, CNKI and references of the included studies up to June 2009 to identify randomized controlled trials (RCTs) that met the inclusion and exclusion criteria,then extracted the data and evaluated the quality of included trials with Cochrane Systematic Review. Meta-analysis was performed using RevMan 5.0 software.Results:Factors through the literature search were obtained in 13 randomized controlled trials, of which four involving 310 patients met the inclusion criteria. met the inclusion criteria.The Meta-analysis showed that the proportion of treatment failures of PE group was significantly lower than that of sham PE group at the end of treatment and the mean change in Kurtzke's DSS scores measured at 6 month of PE group had no significant difference compared to sham PE group,whereas there was greater for the proportion of improvers at 6 month in those patients receiving true PE as opposed to sham PE.Moreover,there was no statistically important difference in the proportion of treatment failures between true PE group and sham PE group either at 12 month or at 24 month,Nor was there difference in the mean change in Kurtzke's DSS scores measured at 12 month.Compared with the incidence of compliances,the incidences of amenorrhoea and hypotension were higher in the PE one than in the sham PE one,but there was no statistically difference in total compliances between the PE one and the sham PE one,as the same to nausea and deep-vein thrombosis。Conclusion:For MS patients,early use of plasma exchange combined with immunosuppressive treatment is effective and safe,but there is no sufficient evidence that plasma exchange can reduce or delay the progress of recurrence。Current studies still need to be confirmed by large sample, high quality randomized controlled trials.