Plasma exchange linked to strong recovery in rare neurologic disease

Clinical takeaway: Consider plasma exchange for severe MOGAD attacks or incomplete response to corticosteroids, particularly in patients with profound vision loss, paralysis, or other disabling neurologic symptoms.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can cause irreversible vision loss or paralysis, and plasma exchange may offer an effective rescue option when corticosteroids provide inadequate improvement.

Plasma exchange was associated with favorable recovery in most patients experiencing MOGAD attacks, according to a systematic review and meta-analysis published in Neurology.

Researchers analyzed 10 studies encompassing 1,045 patients and 1,368 MOGAD attacks. Optic neuritis accounted for 41% of attacks, while 29% involved a combination of optic neuritis, spinal cord symptoms, and cerebral symptoms. Another 12% involved isolated spinal cord manifestations. Mean follow-up was approximately 11 months.

Among patients with optic neuritis, 81% achieved excellent recovery after plasma exchange, defined as complete or nearly complete symptom resolution and visual acuity of at least 20/25. Among patients with additional spinal cord or brain involvement, 94% experienced good recovery, meaning meaningful functional improvement without necessarily returning to their pre-attack baseline.

Treatment-related adverse events occurred in 3% of patients.

“This evidence is exciting, as many people do not respond well to the main steroid treatment for MOGAD, and without quick, effective treatment some of the damage can be irreversible,” said study author Marina Vilardo, MD.

The authors emphasized that the observational evidence establishes an association rather than proving that plasma exchange caused the improvements. Differences in study methods and outcome definitions also limited the certainty of the findings. Prospective, standardized studies are needed to determine optimal timing, treatment protocols, and patient selection.

Source: Vilardo M, et al. (2026 July 22) Neurology. Effectiveness and Safety of Plasmapheresis in MOGAD Attacks: A Systematic Review and Meta-Analysis