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Review
. 2021 Nov 25:13:11795735211057314.
doi: 10.1177/11795735211057314. eCollection 2021.

Consensus recommendation on the use of therapeutic plasma exchange for adult neurological diseases in Southeast Asia from the Southeast Asia therapeutic plasma exchange consortium

Fu Liong Hiew  1 , Win Min Thit  2   3 , Mathew Alexander  4 , Umapathi Thirugnanam  5 , Sasitorn Siritho  6 , Kevin Tan  5 , Seinn Mya Mya Aye  7 , Ohnmar Ohnmar  2   3 , Riwanti Estiasari  8 , Norazieda Yassin  9 , Paul Matthew Pasco  10 , Say Saysavath Keosodsay  11 , Hoang Tien Trong Nghia  12 , Md Badrul Islam  13 , Sing Keat Wong  1 , Shirley Lee  1 , Anupam Chhabra  14 , Shanthi Viswanathan  1
Affiliations
Review

Consensus recommendation on the use of therapeutic plasma exchange for adult neurological diseases in Southeast Asia from the Southeast Asia therapeutic plasma exchange consortium

Fu Liong Hiew et al. J Cent Nerv Syst Dis. .

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.

Keywords: Southeast Asia; autoimmune neurological disorders; central nervous system; peripheral nervous system; plasmapheresis; therapeutic plasma exchange.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Management algorithm for autoimmune neurological disorders.Consider alternative diagnosis. Abbreviations: ADEM, acute disseminated encephalomyelitis; CASPR2: contactin associated protein 2; CIDP, chronic inflammatory demyelinating polyneuropathy; GBS, Guillain-Barré Syndrome; IVIg, intravenous immunoglobulin; LGI1: leucine-rich glioma-inactivated 1; MG, myasthenia gravis; MS: multiple sclerosis; NMDAR: N-Methyl-D-Aspartate Receptor; NMOSD, neuromyelitis optica spectrum disorders; TPE, therapeutic plasma exchange
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References

    1. *Papers of particular interest, published recently, have been highlighted as: •• Of importance, • Of major importance.
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