Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Authors' reply

Plasma exchange: are bigger studies necessarily better?

Nature Reviews Neurology volume 8, page 410 (2012)Cite this article

Subjects

Access through your institution
Buy or subscribe

We thank Dr Weinshenker for the opportunity to expand on our commentary on the value of plasma exchange in neurological disorders (Neuroimmunology: Assessing the value of plasma exchange in neurology. Nat. Rev. Neurol. 7, 309–310; 2011)1 in which editorial constraints prevented us from referring to all the randomized trials conducted in the field including his and our own. We acknowledge that his crossover trial of plasma exchange in 22 patients with a variety of different acute demyelinating diseases provides the best available evidence for the management of this group of patients (Plasmapheresis: are bigger studies necessarily better? Nat. Rev. Neurol. doi:10.1038/nrneurol.2011.59-c1).2,3 The discovery of anti-aquaporin-4 antibodies in neuromyelitis optica has shown that acute demyelinating diseases have a heterogeneous pathology. It will now be important to obtain further evidence for the efficacy of plasma exchange in different subgroups. We agree that small trials are useful and necessary in rare conditions and that the evidence of two or more trials can be synthesized with careful meta-analysis as commonly done in Cochrane reviews.

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Hughes, R. & Hartung, H. P. Neuroimmunology: Assessing the value of plasma exchange in neurology. Nat. Rev. Neurol. 7, 309–310 (2011).

    Article  Google Scholar 

  2. Weinshenker, B. Plasmapheresis: are bigger studies necessarily better? Nat. Rev. Neurol. http://dx.doi.org/10.1038/nrneurol.2011.59-c1.

  3. Weinshenker, B. G. et al. A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann. Neurol. 46, 878–886 (1999).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cochrane Neuromuscular Disease Centre, MRC Centre for Neuromuscular Disease, PO Box 114, National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG, London, UK

    Richard Hughes

  2. Department of Neurology, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany

    Hans-Peter Hartung

Authors
  1. Richard Hughes
    View author publications

    Search author on:PubMed Google Scholar

  2. Hans-Peter Hartung
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Richard Hughes.

Ethics declarations

Competing interests

R. Hughes is a consultant for Baxter, Grifols/Talecris, LFB, Novartis and Octapharma. H.-P. Hartung is a consultant and speaker for Baxter, Biogen Idec, Bayer Schering, CSL Behring, Grifols, Novartis, Merck Serono and Teva.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hughes, R., Hartung, HP. Plasma exchange: are bigger studies necessarily better?. Nat Rev Neurol 8, 410 (2012). https://doi.org/10.1038/nrneurol.2011.59-c2

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/nrneurol.2011.59-c2

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing