VP168 Assessment Of Plasmapheresis For Alzheimer's Disease Systematic Review

• Published in: International journal of technology assessment in health care Vol. 33; no. S1; p. 227
• Main Authors: Luengo-Matos, Setefilla, Polo-Desantos, Mar, Sanchez-Gomez, Luis Maria, Orrego, Juan Pablo Chalco
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 2017
• Subjects: Alzheimer's disease; Apheresis; Brain; Cerebrospinal fluid; Clinical trials; Cognitive ability; Dementia disorders; Effectiveness; Hippocampus; Medical imaging; Neurodegenerative diseases; Neuroimaging; Neurology; Peptides; Pilot projects; Plasma; Plasma levels; Plasmapheresis; Quality assessment; Safety; Side effects; Systematic review; Vignette Presentations
• ISSN: 0266-4623; 1471-6348
• DOI: 10.1017/S0266462317004044

INTRODUCTION: Alzheimer's disease (AD) is the most common type of dementia. Plasmapheresis is a procedure consisting of removing the plasma, or specific elements which are considered to be involved in pathological processes. Plasmapheresis could reduce the A beta peptides load in the brain. The objective is to study the safety and efficacy of plasmapheresis for AD. METHODS: Systematic review, with all studies published before April 2016 reviewed. Selected studies included patients with AD treated with plasmapheresis. GRADE was used to assess quality. Efficacy outcomes include: (i) Cognitive, functional and behavior status, through Mini Mental State Examination, and Alzheimer Disease Assessment Scale-Cognitive test; (ii) Plasma and cerebrospinal fluid A beta levels; (iii) Brain-imaging and functional neuroimaging studies. Safety outcomes included side effects related to the treatment. RESULTS: Two papers reporting results from three studies were selected: (i) pilot study (n = 10), (ii) its extended study (12 months more of follow-up) (n = 7), and (iii) clinical trial (n = 39). The quality of evidence was very low. About efficacy, the studies didn't report quantitative results and were inconclusive. The pilot study and its extended study reported (1): a tendency towards stabilization in cognitive status; the plasma levels of A beta peptides didn't show a clear pattern; and the brain-imaging assessment suggested a progressive volume increase in the hippocampus. The clinical trial reported in the experimental group vs control (2): a better score for the cognitive status; an increase of plasma A beta peptides; and did not find significant differences between groups for cerebrospinal fluid A beta peptides. The brain-imaging assessment showed a progressive loss of hippocampus volume in both groups. Regarding safety, the studies didn't report quantitative data. We didn't find economic evaluation studies. CONCLUSIONS: The included studies had very high risk of bias and very low quality. We found no evidence on efficacy and safety of plasmapheresis treating AD. Plasmapheresis isn't a priority line in research of AD treatment.