Effects of therapeutic plasma exchange (TPE) on efficacy and adverse events in patients with autoimmune neurological diseases: a systematic review and meta-analysis based on real-world studies and single-arm clinical trials.

Background: Therapeutic plasma exchange (TPE) is a core intervention for autoimmune neurological diseases (ANDs). To date, clinical efficacy and safety of TPE across disease subtypes, age strata and regions have not been systematically synthesized. This meta-analysis aimed to evaluate the clinical response, mortality and adverse event (AE) rates of TPE in patients with ANDs. Methods: Relevant real-world observational studies and single-arm trials were retrieved from PubMed, Embase and Cochrane Library. We conducted single-arm meta-analysis to pool effect sizes with 95% confidence intervals (CIs). Subgroup and leave-one-out sensitivity analyses were used to assess heterogeneity and result stability. Results: In total, 38 studies comprising 2,199 patients were included. Response rates differed significantly across study-level age strata, whereas differences across disease and regional subgroups were not statistically significant. The all-cause in-hospital mortality rate among patients undergoing TPE was 4% (95% CI: 3-5%, Conclusion: Patients with ANDs show a relatively high rate of clinical improvement after TPE. Most deaths are attributable to underlying disease progression rather than TPE itself. Further high-quality multicenter studies are required to optimize patient selection and treatment protocols for TPE.