METAANALYSIS OF CLINICAL-STUDIES OF THE EFFICACY OF PLASMA-EXCHANGE IN THE TREATMENT OF CHRONIC PROGRESSIVE MULTIPLE-SCLEROSIS

OBJECTIVE: To examine the hypothesis that addition of therapeutic plas ma exchange (TPEX) to an immunosuppressive drug regimen increases that regimen's efficacy to halt the progression of chronic progressive mul tiple sclerosis (CPMS). METHODS: The literature was searched for prosp ective controlled clinical trials evaluating the efficacy of TPEX in C PMS. Six studies were eligible for meta-analysis. Their results were c ombined, using Cochran's and Pete's methods. Three outcome measures we re studied: 1) the change in Kurtzke's disability status scale (DSS) s cores, 2) the relative odds of neurologic decline by 1 or more DSS gra des, and 3) the relative odds of neurologic improvement by 1 or more D SS grades, in the treatment versus the comparison group of patients. R eported results of neurologic evaluations at 6, 12, 24, and 36 months of follow-up were analyzed separately. RESULTS: TPEX significantly (P < .05) reduced the proportion of patients who experienced neurologic d ecline (by 1 or more DSS grades) at 12 months of follow-up (relative o dds of decline = 0.441, 95% confidence interval = 0.210-0.929). CONCLU SIONS: There is a need for further clinical research into the possibil ity of a beneficial effect of TPEX in patients with CPMS likely to exp erience neurologic decline over the ensuring 12 months. Targeting trea tment to a particular subgroup of CPMS patients may be necessary for T PEX to prove effective. (C) 1995 Wiley-Liss, Inc.