Consensus recommendation on the use of therapeutic plasma exchange for adult neurological diseases in Southeast Asia from the Southeast Asia therapeutic plasma exchange consortium
Year: 2021
Type: review
Abstract: Therapeutic plasma exchange (TPE) is an effective and affordable treatment option in most parts of Southeast Asia (SEA). In 2018, the SEA TPE Consortium (SEATPEC) was established, consisting of regional neurologists working to improve outcome of various autoimmune neurological diseases. We proposed an immunotherapeutic guideline prioritizing TPE for this region. We reviewed disease burden, evidence-based treatment options, and major guidelines for common autoimmune neurological disorders seen in SEA. A modified treatment algorithm based on consensus agreement by key-opinion leaders was proposed. Autoimmune antibody diagnostic testing through collaboration with accredited laboratories was established. Choice of first-line immunotherapies (IVIg/corticosteroid/TPE) is based on available evidence, clinicians' experience, contraindications, local availability, and affordability. TPE could be chosen as first-line therapy for GBS, CIDP, MG (acute/short term), IgG, A paraproteinemic neuropathy, and NMDAR encephalitis. Treatment is stopped for acute monophasic conditions such as GBS and ADEM following satisfactory outcome. For chronic immune disorders, a therapy taper or long-term maintenance therapy is recommended depending on the defined clinical state. TPE as second-line treatment is indicated for IVIg or corticosteroids refractory cases of ADEM, NMOSD (acute), MG, and NMDAR/LGI1/CASPR2/Hashimoto's encephalitis. With better diagnosis, treatment initiation with TPE is a sustainable and effective immunotherapy for autoimmune neurological diseases in SEA.
Authors: Fu Liong Hiew, Win Min Thit, Mathew Alexander, Umapathi Thirugnanam, Sasitorn Siritho, Kevin Tan, Seinn Mya Mya Aye, Ohnmar Ohnmar, Riwanti Estiasari, Norazieda Yassin, Paul Matthew Pasco, Say Saysavath Keosodsay, Hoang Tien Trong Nghia, MD Badrul Islam, Sing Keat Wong, Shirley Lee, Anupam Chhabra, Shanthi Viswanathan
Institutions: Hospital Kuala Lumpur, University Of Medicine 1 Yangon, Yangon General Hospital, National Neuroscience Institute, Siriraj Hospital, Bumrungrad International Hospital, University of Indonesia, Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, Philippine General Hospital, Ministry of Health, International Centre for Diarrhoeal Disease Research
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,600
OpenAlex ID: W3216763589