Efficacy and Safety of Plasma Exchange and Immunoadsorption for Acute Optic Neuritis in Patients with Demyelinating Diseases: A Systematic Review and Meta-Analysis

Authors

• Mehenaz A Hanbazazh, Division of Pathology, Department of Basic Medical Sciences, College of Medicine, University of Jeddah, Jeddah, Saudi ArabiaFollow
• Mohammed Ridha Algethami, Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi ArabiaFollow
• Abdulwahhab Omar AnbarSerry, Collage of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaFollow
• Ruba Mohammed Alghanmi, College of Medicine, University of Jeddah, Jeddah, Saudi ArabiaFollow
• Lama Nawaf Alanazi, Collage of Medicine, King Faisal University, Al-Ahsa, Saudi ArabiaFollow
• Ahmed Ayed N Alanazi, College of Medicine and Health Sciences, Arabian Gulf University, Manama, BahrainFollow
• Bashaier Gubran AlQahtani, Prince Sultan Military Medical City, Riyadh, Saudi ArabiaFollow
• Mohammed Abdullah Alamri, Collage of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaFollow

Abstract

Background: Optic neuritis (ON), a common manifestation of demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), often leads to significant visual impairment. Although high-dose corticosteroids are a first-line therapy, many patients experience incomplete recovery. Apheresis therapies, including plasma exchange (PLEX) and immunoadsorption (IA), are being increasingly used as rescue treatments, but their efficacy and safety are debated.

Methods: We conducted a systematic review and meta-analysis of studies evaluating PLEX and IA for acute ON in patients with demyelinating diseases. Four databases were searched up to January 2025. The included studies reported visual or neurological outcomes in patients with MS, NMOSD, MOGAD, or idiopathic ON. The primary outcomes were treatment response and visual acuity changes (logMAR). The study quality was assessed using RoB 2, ROBINS-I, or JBI tools. Random effects models were employed for the meta-analysis.

Results: Twelve studies (800+ ON attacks) were analyzed. Both PLEX and IA demonstrated significant visual improvement, with a pooled mean logMAR reduction of -1.11 (95% CI: -1.70 to -0.53). Early intervention correlated with better outcomes. MOGAD-ON patients showed the highest response rates, while delayed treatment in NMOSD-ON patients was linked to poorer vision. Adverse events were rare and mild.

Conclusion: PLEX and IA are effective and safe second-line therapies for steroid-refractory ON, particularly when initiated early. These findings support the prompt use of apheresis in eligible patients to optimize visual recovery.

Article Type

Systematic Review

First Page

220

Last Page

229

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

Recommended Citation

Hanbazazh, Mehenaz A; Algethami, Mohammed Ridha; AnbarSerry, Abdulwahhab Omar; Alghanmi, Ruba Mohammed; Alanazi, Lama Nawaf; Alanazi, Ahmed Ayed N; AlQahtani, Bashaier Gubran; and Alamri, Mohammed Abdullah (2026) "Efficacy and Safety of Plasma Exchange and Immunoadsorption for Acute Optic Neuritis in Patients with Demyelinating Diseases: A Systematic Review and Meta-Analysis," Neurosciences: Vol. 31: Iss. 3, Article 3.
DOI: https://doi.org/10.17712/1658-3183.2798