TY - JOUR AU - Chico-Garcia,J.L. AU - Morales de la Prida,M. AU - Boix Lago,A. AU - García-Domínguez,J.M. AU - Sepúlveda,M. AU - Martínez-Hernández,E. AU - Guasp,M. AU - Fonseca,E. AU - Calvi,A. AU - Alba-Isasi,M.T. AU - Albertí,B. AU - Cid,J. AU - Lozano,M. AU - Charry,P. AU - Rodríguez-Jorge,F. AU - Sainz-Amo,R. AU - Sainz de la Maza,S. AU - Monreal,E. AU - Villar,L.M. AU - Masjuan,J. AU - Valero-López,G. AU - Millán-Pascual,J. AU - Cuello,J.P. AU - Palacios,M. AU - Gifreu Fraixinó,A. AU - Martínez-Gins,M.L. AU - Álvarez Bravo,G. AU - Meca-Lallana,J.E. AU - Costa-Frossard,L. AU - Blanco,Y. AU - Cabrera-Maqueda,J.M. AU - Saiz,A. AU - Llufriu,S. KW - demyelinating KW - intravenous immunoglobulins KW - multiple sclerosis KW - neuromyelitis optica KW - plasma exchange KW - rituximab T1 - Rituximab and IVIG added to plasma exchange improves the outcome of severe CNS demyelinating attacks: a retrospective study LA - eng PY - 2026/01/01/ T2 - Therapeutic Advances in Neurological Disorders SN - 1756-2864 VL - 19 PB - SAGE Publications Ltd AB - Background: 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. Objective: 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. Design: Retrospective analysis of patients with CNS demyelinating attacks treated with PE between 2012 and 2023 across five Spanish hospitals. Methods: Clinical response was measured as an improvement or a complete recovery at discharge and 6 months. 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. Results: 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 years (interquartile range 33–52.75)) were analyzed. At discharge, 60% of all attacks showed clinical improvement, and 15% achieved complete recovery. At 6 months, 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 months. IPTW analysis showed that attacks treated with RTX-IVIG-PE (33) were associated with improvement (adjusted odds ratio (aOR) 5.4, p < 0.001) and complete recovery (aOR 4.55, p < 0.001) at 6 months compared to those treated with standard PE (129), without significant differences in the adverse event profile between the two protocols. Conclusion: 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. DO - 10.1177/17562864261440665 UR - https://portalcientifico.uah.es/documentos/6a0911c712db65736a51bc92 DP - Dialnet - Portal de la Investigación ER -