{"publication_id":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","traces":[{"claim_id":"claim_1","claim":"This paper synthesizes evidence on Therapeutic plasma exchange across 28 accepted source papers and 1449 high-confidence extracted claims. The evidence profile contains 4 direct clinical sources, 24 adjacent clinical sources, and no sources classified primarily as mechanistic or model-system evidence, with a high-density pairwise disagreement map across the evidence base. No single positive outcome class dominates the retained corpus; null signals cluster in the contextual adjacent evidence, immune and inflammation, safety and comorbidity outcome classes, and negative signals cluster in the contextual adjacent evidence outcome class. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect. The conclusion is that Therapeutic plasma exchange remains a bounded geroscience case: the retained clinical and adjacent evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified anti-aging claim.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_2","claim":"This paper synthesizes evidence on Therapeutic plasma exchange across 28 accepted source papers and 1449 high-confidence extracted claims.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_3","claim":"The evidence profile contains 4 direct clinical sources, 24 adjacent clinical sources, and no sources classified primarily as mechanistic or model-system evidence, with a high-density pairwise disagreement map across the evidence base.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_4","claim":"No single positive outcome class dominates the retained corpus; null signals cluster in the contextual adjacent evidence, immune and inflammation, safety and comorbidity outcome classes, and negative signals cluster in the contextual adjacent evidence outcome class. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_5","claim":"The conclusion is that Therapeutic plasma exchange remains a bounded geroscience case: the retained clinical and adjacent evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified anti-aging claim.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_6","claim":"This manuscript is reported as a Thin-corpus evidence brief. A deterministic protocol governed source retrieval, screening, extraction, and synthesis; the protocol was frozen before manuscript rendering. The full audit trail is in the supplementary `methods_pack.json` and the timestamped submission directory `synthesis-therapeutic_plasma_exchange-v06-DAILY-2026-06-28T04-15-17Z`.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_7","claim":"The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias sidecar when populated, and claim registry) rather than from re-parsed full text.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_8","claim":"Risk-of-bias framework assignment follows study design (RoB-2 for RCTs, ROBINS-I for non-randomised studies, AMSTAR-2 for systematic reviews / meta-analyses). Public appraisal claims are limited to populated `risk_of_bias.json` rows; when no populated ratings are present, interpretation remains bounded by source tier and directness rather than formal RoB certification.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_9","claim":"Evidence-tension synthesis: claims grouped by outcome class (contextual adjacent evidence, dosing and pharmacokinetics, immune and inflammation, longevity, mortality and survival, safety and comorbidity); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_10","claim":"Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary `manifest.json`. Final eligibility and interpretation decisions are author-verified.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_11","claim":"Scope-framing note: This evidence map frames Therapeutic plasma exchange as clinical applications across heterogeneous indications rather than as standalone anti-aging or longevity proof. Aging-relevant interpretation is restricted to source rows whose endpoint, population, and outcome-class metadata directly support it; otherwise the retained evidence is contextual and hypothesis-generating.","citation_support":[],"candidate_sources":[{"study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257.","source_id":"source_1","support_kind":"candidate_source_row"},{"study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = .","source_id":"source_2","support_kind":"candidate_source_row"},{"study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy.","source_id":"source_3","support_kind":"candidate_source_row"},{"study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD.","source_id":"source_4","support_kind":"candidate_source_row"},{"study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients.","source_id":"source_5","support_kind":"candidate_source_row"}]},{"claim_id":"claim_12","claim":"Boada 2020: A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study: outcome=Contextual Adjacent Evidence; direction=unclear; directness=direct; tier=A1; finding=representative statistic P = .03; source-level statistic reported.","citation_support":[{"source_id":"source_2","study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","support_kind":"cited_as_match","cited_as":"Boada 2020","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"direct","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = ."}],"candidate_sources":[]},{"claim_id":"claim_13","claim":"Ipe 2021: Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence: outcome=Contextual Adjacent Evidence; direction=negative; directness=review; tier=B2; finding=representative statistic p ≥ 0.05; source-level statistic reported.","citation_support":[{"source_id":"source_3","study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","support_kind":"cited_as_match","cited_as":"Ipe 2021","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy."}],"candidate_sources":[]},{"claim_id":"claim_14","claim":"Boada 2021: Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study: outcome=Contextual Adjacent Evidence; direction=unclear; directness=review; tier=B2; finding=representative statistic P = .06; source-level statistic reported.","citation_support":[{"source_id":"source_4","study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","support_kind":"cited_as_match","cited_as":"Boada 2021","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD."}],"candidate_sources":[]},{"claim_id":"claim_15","claim":"Eichinger 2025: Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders: outcome=Immune and Inflammation; direction=null; directness=indirect; tier=B2; finding=representative statistic p < 0.05; source-level statistic reported.","citation_support":[{"source_id":"source_5","study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","support_kind":"cited_as_match","cited_as":"Eichinger 2025","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients."}],"candidate_sources":[]},{"claim_id":"claim_16","claim":"Lee 2026: Pediatric Therapeutic Plasma Exchange: Characterization of Practice, Epidemiology, and Safety Profile at a Children's Hospital in the United States: outcome=Safety and Comorbidity; direction=null; directness=indirect; tier=B2; finding=46 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_6","study":"Pediatric Therapeutic Plasma Exchange: Characterization of Practice, Epidemiology, and Safety Profile at a Children's Hospital in the United States","doi":"10.1002/jca.70128","url":"https://doi.org/10.1002/jca.70128","support_kind":"cited_as_match","cited_as":"Lee 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"There is a need to better understand the indications and safety profiles for therapeutic plasma exchange (TPE) in children. We aimed to assess pediatric TPE practice at a large academic center by retrospective chart review from 2011 to 2022. Patient demographics and clinical information including American Society for Apheresis (ASFA) category were analyzed. The cohort consisted of 438 patients, 52.1% female with a median age of 11.4 years, who underwent 3385 TPE procedures. The adverse reaction rate was 6.8%, with hypotension being most common. Tandem circuits were used in 3.9% of procedures, and the adverse reaction rate was significantly higher, 16.1% (p = < 0.05). Cryoprecipitate transfusion occurred in 29.0% of procedures for hypofibrinogenemia (median treatment number 3) and 19.1% of procedures required an RBC prime. Our findings highlight contemporary practical considerations for running a pediatric apheresis service, provide insight into managing tandem procedures, and may provide guidance for future research endeavors and clinical practice."}],"candidate_sources":[]},{"claim_id":"claim_17","claim":"Salur 2026: The Role of Therapeutic Plasma Exchange in the Management of Myeloma-Related Cast Nephropathy: A 10-Year Real-World Cohort Study: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; finding=representative statistic p = 0.378; source-level statistic reported.","citation_support":[{"source_id":"source_7","study":"The Role of Therapeutic Plasma Exchange in the Management of Myeloma-Related Cast Nephropathy: A 10-Year Real-World Cohort Study","doi":"10.3390/jcm15020417","url":"https://doi.org/10.3390/jcm15020417","support_kind":"cited_as_match","cited_as":"Salur 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"Background: Renal impairment is a frequent and severe complication of multiple myeloma, most commonly caused by light-chain cast nephropathy. Therapeutic plasma exchange (TPE) has been proposed as an adjunctive approach to rapidly reduce circulating free light chains; however, its clinical benefit remains controversial. Methods: We retrospectively analyzed 71 patients treated between 2013 and 2023, of whom 30 received TPE in addition to anti-myeloma therapy and 41 received anti-myeloma therapy alone. Renal outcomes were assessed within a predefined early treatment window encompassing the first 4-6 cycles of therapy. Renal response was defined as a ≥50% reduction in serum creatinine and/or dialysis independence. Multivariable logistic regression and sensitivity analyses were performed to adjust for baseline imbalances, including renal function and anti-myeloma backbone therapy. Results: Although renal function improved significantly over time in both groups, renal response rates were comparable between patients treated with and without TPE (40% vs. 36.6%). In multivariable analysis, TPE was not independently associated with renal response."}],"candidate_sources":[]},{"claim_id":"claim_18","claim":"Fuentealba 2025: Multi‐Omics Analysis Reveals Biomarkers That Contribute to Biological Age Rejuvenation in Response to Single‐Blinded Randomized Placebo‐Controlled Therapeutic Plasma Exchange: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; finding=representative statistic p < 0.048; source-level statistic reported.","citation_support":[{"source_id":"source_8","study":"Multi‐Omics Analysis Reveals Biomarkers That Contribute to Biological Age Rejuvenation in Response to Single‐Blinded Randomized Placebo‐Controlled Therapeutic Plasma Exchange","doi":"10.1111/acel.70103","url":"https://doi.org/10.1111/acel.70103","support_kind":"cited_as_match","cited_as":"Fuentealba 2025","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"We conducted a randomized, placebo-controlled trial to assess the safety and biological age (BA) effects of various therapeutic plasma exchange (TPE) regimens in healthy adults over 50. Participants received bi-weekly TPE with or without intravenous immunoglobulin (IVIG), monthly TPE, or placebo. Randomization was based on entry date, and treatments were blinded to maintain objectivity. Primary objectives were to assess long-term TPE safety and changes in biological clocks. Secondary goals included identifying optimal regimens. Exploratory analyses profiled baseline clinical features and longitudinal changes across the epigenome, proteome, metabolome, glycome, immune cytokines, iAge, and immune cell composition. We demonstrate in 42 individuals randomized to various treatment arms or placebo that long-term TPE was found to be safe, with only two adverse events requiring discontinuation and one related to IVIG. TPE significantly improved biological age markers, with 15 epigenetic clocks showing rejuvenation compared to placebo (FDR < 0.05)."}],"candidate_sources":[]},{"claim_id":"claim_19","claim":"Kohli 2022: Effect on haemostasis of different replacement fluids during therapeutic plasma exchange—A comparative multicentre observational study: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; finding=30 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_11","study":"Effect on haemostasis of different replacement fluids during therapeutic plasma exchange—A comparative multicentre observational study","doi":"10.1002/jca.22008","url":"https://doi.org/10.1002/jca.22008","support_kind":"cited_as_match","cited_as":"Kohli 2022","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"INTRODUCTION: Therapeutic plasma exchange (TPE) is used for several chronic conditions with little evidence on the efficacy and safety of different choice of replacement fluid. Measurement of haemostasis, particularly in vitro thrombin generation, could play a role in determining the immediate efficacy of different fluid replacement. AIM: To determine the impact of different TPE replacement fluid regimens on haemostatic assays. METHODS: Prospective observational multi-centre cohort study in adult patients 18 years and older evaluating haemostatic changes between four different TPE regimens: (1) 5% human albumin solution (Alb) only, (2) 50:50 mix of 5% Alb + modified gelatin, (3) 70:30 mix of 5% Alb and normal saline (NS), and (4) solvent-detergent, virus-inactivated fresh frozen plasma (FFP) (either alone or combined with other fluids). Twenty-one haemostasis variables were analysed (procoagulant, anticoagulant and fibrinolytic factors) pre and post TPE sessions, including in vitro thrombin generation. Linear mixed modelling and canonical discriminant analyses were used to examine the effect of TPE fluid type on haemostatic variables."}],"candidate_sources":[]},{"claim_id":"claim_20","claim":"Espana-Cueto 2025: Plasma exchange therapy for the post COVID-19 condition: a phase II, double-blind, placebo-controlled, randomized trial: outcome=Contextual Adjacent Evidence; direction=null; directness=direct; tier=A1; finding=26 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_13","study":"Plasma exchange therapy for the post COVID-19 condition: a phase II, double-blind, placebo-controlled, randomized trial","doi":"10.1038/s41467-025-57198-7","url":"https://doi.org/10.1038/s41467-025-57198-7","support_kind":"cited_as_match","cited_as":"Espana-Cueto 2025","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"direct","excerpt":"The post-COVID-19 condition (PCC) is a highly debilitating and persistent postinfectious syndrome that affects millions of people worldwide and has no effective treatment. Therapeutic plasma exchange (TPE) has the potential to improve the PCC by clearing the peripheral soluble pro-inflammatory immune milieu derived from acute or persistent SARS-CoV-2 infection. In a phase II, double-blind, placebo-controlled, randomized trial, fifty subjects with PCC were randomly assigned (1:1) to receive six sessions of either TPE or a sham plasma exchange and were followed for 90 days (ClinicalTrials.gov registration: NCT05445674). The primary endpoint was safety; secondary endpoints included functional status, symptomology, quality of life, neurocognitive symptoms, and peripheral biochemistry, hematology, coagulation and inflammation parameters. Both study arms had a similarly favorable safety profile. There were no diferences between groups in any of the efficacy parameters evaluated. Whereas TPE is safe, it did not lead to any discernible improvement of the PCC in this clinical trial."}],"candidate_sources":[]},{"claim_id":"claim_21","claim":"Thomas 2026: Severe autoimmune diffuse alveolar hemorrhage in children; early diagnosis and initiation of therapeutic plasma exchange may improve clinical outcomes: outcome=adjacent clinical-context evidence; direction=null; directness=indirect; tier=B2; finding=22 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_14","study":"Severe autoimmune diffuse alveolar hemorrhage in children; early diagnosis and initiation of therapeutic plasma exchange may improve clinical outcomes","doi":"10.3389/fped.2026.1799535","url":"https://doi.org/10.3389/fped.2026.1799535","support_kind":"cited_as_match","cited_as":"Thomas 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"INTRODUCTION: Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening pulmonary complication in children, presenting with hemoptysis, anemia, diffuse infiltrates, and respiratory failure. Autoimmune diseases such as systemic lupus erythematosus (SLE) and ANCA-associated vasculitis (AAV) account for 30%-40% of pediatric DAH cases. Pediatric evidence is limited to case reports and small series. We aimed to characterize the clinical course, management, and outcomes of pediatric patients with autoimmune DAH requiring intensive care. METHODS: We conducted a retrospective cohort study at a single tertiary pediatric institution, identifying 6 patients admitted to the ICU from 2013 to 2024 with DAH secondary to SLE or AAV. RESULTS: All six patients (5 females; age 14-17) were critically ill. Five required MV (median 18 days, IQR: 18-25), two required high-frequency oscillatory ventilation (HFOV) (6, 10 days), and three required VV-ECMO (8, 9, and 45 days). Four had new-onset autoimmune diagnoses on admission. All received high-dose corticosteroids and therapeutic plasma exchange (TPE) (mean 6.5 ± 2."}],"candidate_sources":[]},{"claim_id":"claim_22","claim":"Williams 2026: “In-Series” Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange: Single-Center Retrospective Cohort, 2018–2022: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; finding=21 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_15","study":"“In-Series” Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange: Single-Center Retrospective Cohort, 2018–2022","doi":"10.1097/PCC.0000000000003942","url":"https://doi.org/10.1097/PCC.0000000000003942","support_kind":"cited_as_match","cited_as":"Williams 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"OBJECTIVES: To describe our use and experience with an \"in-series\" approach for patients requiring both continuous renal replacement therapy (CRRT) as well as therapeutic plasma exchange (TPE). DESIGN: Retrospective review of case notes. SETTING: General and cardiac PICUs at the Royal Children's Hospital in Melbourne, VIC, Australia. PATIENTS: Children (0-18 yr old) requiring both CRRT and TPE between 2018 and 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twelve children were successfully and safely treated with 32 TPE sessions and 38 CRRT sessions with our in-series CRRT and TPE setup using a total of 20 extracorporeal circuits and 11 additional plasma filters or hemofilters. This represents a reduction of 71% in standard circuit usage. CONCLUSIONS: Our approach to providing \"in-series\" CRRT and TPE used existing access and circuits, a single device, and resulted in efficient treatments, reduced infection risk, reduced exposure to circuits, less hemodilution, and less blood product use. Small potential cost and waste reductions were also achieved. This approach was performed safely with no unexpected adverse events."}],"candidate_sources":[]},{"claim_id":"claim_23","claim":"Kularathna 2026: Clinical Experience of Therapeutic Plasma Exchange (TPE) in Severe Leptospirosis: A Case Series from Sri Lanka: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; finding=representative statistic p < 0.001; source-level statistic reported.","citation_support":[{"source_id":"source_16","study":"Clinical Experience of Therapeutic Plasma Exchange (TPE) in Severe Leptospirosis: A Case Series from Sri Lanka","doi":"10.3390/tropicalmed11050132","url":"https://doi.org/10.3390/tropicalmed11050132","support_kind":"cited_as_match","cited_as":"Kularathna 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"BACKGROUND: Leptospirosis is a globally prevalent zoonosis with significant morbidity and mortality, especially in tropical regions like South Asia. In its severe form, the disease often leads to multiorgan dysfunction, with pulmonary haemorrhage being a major cause of death. Evidence supporting specific treatments for severe leptospirosis with pulmonary involvement remains limited. Recent studies suggest that immunomodulatory therapies, such as therapeutic plasma exchange (TPE), may offer survival benefits. This case series explores the application and outcomes of TPE in patients with severe leptospirosis at a tertiary care hospital in Sri Lanka. METHODS: We studied a case series involving nine patients with confirmed severe leptospirosis and multiorgan involvement from September 2021 to October 2022. All patients received standard care, including intravenous antibiotics and methylprednisolone. TPE was initiated in all nine patients based on clinical severity, particularly in the presence of pulmonary haemorrhage. Clinical, laboratory, and radiological data were collected from patient records and follow-up. Leptospirosis diagnosis was confirmed through ELISA IgM testing."}],"candidate_sources":[]},{"claim_id":"claim_24","claim":"Tupin 2026: Pathogen‐reduced plasma, cryoprecipitate reduced for therapeutic plasma exchange: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; finding=17 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_17","study":"Pathogen‐reduced plasma, cryoprecipitate reduced for therapeutic plasma exchange","doi":"10.1111/trf.70099","url":"https://doi.org/10.1111/trf.70099","support_kind":"cited_as_match","cited_as":"Tupin 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) for thrombotic thrombocytopenic purpura (TTP) and auto-immune disorders involves repeated patient exposure to allogenic plasma with the risk of transfusion-transmitted infection (TTI). Amotosalen-UVA Pathogen Reduction technology is FDA approved to manufacture pathogen-reduced plasma, cryoprecipitate reduced (PRPCR), a form of cryoprecipitate poor plasma (CPP) with potentially improved TPE outcomes and reduced TTI risk. METHODS: PRPCR was manufactured from pathogen-reduced (PR) plasma. Thrombin generation, fibrinogen, Factors II, V, VII, VIII, IX, X, XI, XIII, VWF, ADAMTS13, Protein C, Protein S, α-2 plasmin inhibitor (α-2 PI), IgG, IgM, and IgA were measured. Microfluidic chamber assays at variable shear rates characterized PRPCR-mediated platelet adhesion and aggregation. RESULTS: Compared to PR plasma, fibrinogen, Factor VIII, and VWF levels were depleted in PRPCR. Factors II, V, VII, IX, X, XI, XIII, thrombin generation, Protein C, Protein S, α-2 PI, ADAMTS13, and immunoglobulins were conserved. At low wall shear rates (300 s -1 ) PRPCR supported platelet adhesion."}],"candidate_sources":[]},{"claim_id":"claim_25","claim":"Krzych 2021: What Is the Role of Therapeutic Plasma Exchange as an Adjunctive Treatment in Severe COVID-19: A Systematic Review: outcome=treatment or intervention-response evidence; direction=null; directness=review; tier=B2; finding=16 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_18","study":"What Is the Role of Therapeutic Plasma Exchange as an Adjunctive Treatment in Severe COVID-19: A Systematic Review","doi":"10.3390/v13081484","url":"https://doi.org/10.3390/v13081484","support_kind":"cited_as_match","cited_as":"Krzych 2021","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"review","excerpt":"INTRODUCTION: Since the COVID-19 pandemic outbreak, multiple promising treatment modalities have been tested, however, only several of them were proven to be effective. Therapeutic plasma exchange (TPE) has been recently discussed as a possible supportive treatment for severe cases. METHODS: To investigate a possible role of TPE in severe COVID-19 we used a structured systematic search strategy to retrieve all relevant publications in the field. We screened in PubMed, EMBASE, Web of Science, Cochrane Library and clinicaltrials.gov for data published until the 4 June 2021. RESULTS: We identified 18 papers, enrolling 384 patients, 220 of whom received TPE. The number of TPE sessions ranged from 1 to 9 and the type of replacement fluid varied markedly between studies (fresh frozen plasma or 5% albumin solution, or convalescent plasma). Biochemical improvement was observed in majority of studies as far as C-reactive protein (CRP), interleukin-6 (IL-6), ferritin, lactate dehydrogenase (LDH), D-dimer concentrations and lymphocyte count are concerned. The improvement at a laboratory level was associated with enhancement of respiratory function."}],"candidate_sources":[]},{"claim_id":"claim_26","claim":"Sgavardea 2026: Towards a clinical decision protocol for therapeutic plasma exchange based on biomarker patterns and machine learning: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; finding=14 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_19","study":"Towards a clinical decision protocol for therapeutic plasma exchange based on biomarker patterns and machine learning","doi":"10.1186/s12911-026-03484-3","url":"https://doi.org/10.1186/s12911-026-03484-3","support_kind":"cited_as_match","cited_as":"Sgavardea 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"INTRODUCTION: Therapeutic plasma exchange (TPE) is increasingly used as an adjunctive intervention in severe, hyperinflammatory critical illness, including COVID-19, yet clinical guidance remains syndromic and evidence is heterogeneous. We present an integrated, interpretable machine-learning framework designed to support protocolizable TPE decision-making by identifying biochemical phenotypes associated with short-horizon laboratory response to TPE. Our dataset consists of real-world intensive care unit cases and captures the treatment heterogeneity and operational constraints that a workable institutional protocol must accommodate, being well-suited as a “protocol seed” for iterative validation. METHODS: We jointly analyze a COVID-19 cohort and a non-COVID comparator cohort receiving TPE. Three decision trees were constructed to represent: (1) global biochemical improvement, (2) strict improvement dependent on key inflammatory/coagulation markers, and (3) early interleukin-6 (IL-6) response. The models revealed distinct favorable phenotypes—particularly patients with IL-6 > 86 pg/mL, lactate dehydrogenase (LDH) >346 U/L, lymphopenia, and fibrinogen ≤ 8.3 g/L."}],"candidate_sources":[]},{"claim_id":"claim_27","claim":"Davidson 2022: Rescuing Cancer Immunity by Plasma Exchange in Metastatic Melanoma (ReCIPE-M1): protocol for a single-institution, open-label safety trial of plasma exchange to clear sPD-L1 for immunotherapy: outcome=Safety and Comorbidity; direction=null; directness=protocol; tier=D1; finding=12 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_20","study":"Rescuing Cancer Immunity by Plasma Exchange in Metastatic Melanoma (ReCIPE-M1): protocol for a single-institution, open-label safety trial of plasma exchange to clear sPD-L1 for immunotherapy","doi":"10.1136/bmjopen-2021-050112","url":"https://doi.org/10.1136/bmjopen-2021-050112","support_kind":"cited_as_match","cited_as":"Davidson 2022","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"protocol","excerpt":"BACKGROUND: Patients with metastatic melanoma rely on PD-(L)1 immunotherapy, but only one-third of patients experience treatment response and all initial responders eventually develop resistance. Tumour-derived extracellular vesicles expressing Programmed death ligand 1 (evPD-L1) and soluble Programmed death ligand 1 (sPD-L1) in peripheral blood of patients with melanoma limit PD-(L)1 immunotherapy and correlate with poor survival. Therapeutic plasma exchange (TPE) removes immunosuppressive evPD-L1 and sPD-L1. We hypothesise that TPE may rescue and restore antimelanoma immunity. METHODS: In this two-arm study, 60 patients with metastatic melanoma progressing on checkpoint inhibition will be accrued. All patients will undergo radiotherapy on days 1-5 (at least one measurable lesion will not be irradiated) and ongoing checkpoint inhibition on day 8 and every 2-3 weeks per standard of care. Patients with baseline sPD-L1 level of ≥1.7 ng/mL and adequate clinical capacity will be enrolled in the TPE intervention arm and will undergo TPE on days 5-7, in addition to standard of care radiotherapy and immunotherapy. Other patients will remain in the standard of care arm."}],"candidate_sources":[]},{"claim_id":"claim_28","claim":"Raval 2026: Bleeding Risk Is Not Increased When Initiating Therapeutic Plasma Exchange in Adults Using Exclusively Albumin Replacement Fluid 2 Days After Percutaneous Kidney Biopsy: outcome=Safety and Comorbidity; direction=null; directness=indirect; tier=B2; finding=representative statistic p ≥ 0.05; source-level statistic reported.","citation_support":[{"source_id":"source_21","study":"Bleeding Risk Is Not Increased When Initiating Therapeutic Plasma Exchange in Adults Using Exclusively Albumin Replacement Fluid 2 Days After Percutaneous Kidney Biopsy","doi":"10.1002/jca.70122","url":"https://doi.org/10.1002/jca.70122","support_kind":"cited_as_match","cited_as":"Raval 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"The practice of selecting replacement fluid for therapeutic plasma exchange (TPE) after percutaneous kidney biopsy is variable and often depends on the number of days after biopsy that the apheresis treatment plan is initiated. It has been previously reported that most centers utilize plasma for at least part of replacement fluid for TPE after kidney biopsy, and quite often for many days. In this retrospective study, 100 consecutive patients who underwent percutaneous kidney biopsy and had TPE initiated 2 days after biopsy were analyzed. Half of these patients had exclusively albumin replacement fluid, and the other half had replacement fluid with both albumin and plasma. Rates for bleeding at the kidney biopsy site were identical and occurred in 1 patient (2%) in each cohort. Future studies assessing bleeding risk in this patient population receiving TPE should concentrate on the duration within 1 day after percutaneous kidney biopsy."}],"candidate_sources":[]},{"claim_id":"claim_29","claim":"Ciobanu 2026: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Successful Therapeutic Plasma Exchange Treatment After SARS‐CoV‐2 Infection—A Case Report: outcome=Immune and Inflammation; direction=null; directness=indirect; tier=B2; finding=7 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_22","study":"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Successful Therapeutic Plasma Exchange Treatment After SARS‐CoV‐2 Infection—A Case Report","doi":"10.1002/ccr3.72725","url":"https://doi.org/10.1002/ccr3.72725","support_kind":"cited_as_match","cited_as":"Ciobanu 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex neuroimmunological disorder characterized by disabling symptoms that are often difficult to manage. More recently, in the context of SARS-CoV-2 infection, potential pathophysiological overlaps and disease modulation have been hypothesized. Our successful case highlights the need to investigate novel therapeutic approaches, including plasma exchange."}],"candidate_sources":[]},{"claim_id":"claim_30","claim":"Nachtigall 2026: Neither Therapeutic Plasma Exchange nor High-Flux Hemodialysis Enhances the Removal of Chlorprothixene in Case of Intoxication despite a Drop in Plasma Levels: A Case Report: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; finding=6 extracted claim(s); receipt-level direction is the coded finding.","citation_support":[{"source_id":"source_23","study":"Neither Therapeutic Plasma Exchange nor High-Flux Hemodialysis Enhances the Removal of Chlorprothixene in Case of Intoxication despite a Drop in Plasma Levels: A Case Report","doi":"10.1159/000551514","url":"https://doi.org/10.1159/000551514","support_kind":"cited_as_match","cited_as":"Nachtigall 2026","population":"not extracted","endpoint":"not extracted","effect":"not extracted","directness":"indirect","excerpt":"INTRODUCTION: Chlorprothixene is a typical antipsychotic, primarily used in the treatment of psychotic disorders. Overdose may result in severe cardiovascular and central nervous system toxicity. Evidence on the effectiveness of extracorporeal elimination is scarce. CASE PRESENTATION: A 19-year-old female ingested 5 g of chlorprothixene in a suicide attempt. Upon admission to the intensive care unit, she was awake, responsive, and oriented. Initial management included 50 g of activated charcoal. As doses of >2 g chlorprothixene can cause severe intoxication and death, attempts to enhance drug elimination by extracorporeal therapy were undertaken. Therapeutic plasma exchange (TPE) was initiated approximately 3 h after admission, exchanging 5,096 mL of plasma with albumin solution and FFP over 3 h 10 min. This was followed by a 10 h 10 min prolonged intermittent kidney replacement therapy (PIKRT). Serial blood, apheresis, and dialyzate samples were collected to quantify drug removal. Both procedures were well tolerated. The patient remained clinically stable and was transferred to a psychiatric facility 24 h post-admission."}],"candidate_sources":[]}]}