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Prospective randomized trial of two different immunoadsorbers in severe systemic lupus erythematosus.
- Source :
-
Journal of autoimmunity [J Autoimmun] 1998 Oct; Vol. 11 (5), pp. 495-501. - Publication Year :
- 1998
-
Abstract
- Experiences with extracorporeal therapy in systemic lupus erythematosus have been published over the last 20 years and more. In addition to plasmapheresis, specific adsorption columns have been developed to deplete pathogenic antibodies and immune complexes in the plasma of patients with SLE. We conducted a prospective randomized trial to compare the efficacy of a disposable adsorption column, which contained a specific ligand, phenylalanine (IMPH-350|Pt, Diamed, Köln, Germany) with a regenerable Ig-adsorbing column containing sheep anti-human antibodies (Ig-Therasorb|Pt, Therasorb, München, Germany). Twenty SLE patients inadequately controlled with corticosteroids, anti-malarials, azathioprine or cyclosporine A, had strong evidence of disease in general, or an organ related SLAM score. They were randomized to receive either a perfusion of IMPH-350, or Ig-Therasorb, immunoadsorbed with 2.5 ml of plasma, three times each. The treatment regime was repeated after 4 weeks when the response was limited or non-existent. Response was defined as a reduction in the SLAM score of at least 30%. SLAM scores in the IMPH group decreased from 14.3+/-5.6 to 9.2+/-6.2 after 1 month and to 9.4+/-3.9 after 6 months; corresponding scores in the Ig-Therasorb group were 18.3+/-5. 5 to 11.2+/-7.6, decreasing to 9.2+/-2.9. After 1 month, 8/10 patients in both groups showed a response; after 6 months, 5/10 patients in the IMPH-350 group and 8/10 in the Ig-Therasorb group fulfilled the response criteria. Reduction of dsDNA antibodies directly after treatment was 50.8+/-6.6% in the IMPH-350 group and 61.0+/-8.0% in the IgTherasorb group. Results indicate that immunoadsorption is an additional option in the treatment of severe SLE. Choice of type of immunoadsorber and immunosuppressive treatment has to take into account the severity and chronicity of common disease activity and organ involvement, as well as economic aspects.<br /> (Copyright 1998 Academic Press.)
- Subjects :
- Adult
Animals
Antibodies, Antinuclear blood
Antibodies, Antinuclear isolation & purification
Antigen-Antibody Complex blood
Antigen-Antibody Complex isolation & purification
Autoantibodies blood
Autoantibodies isolation & purification
Female
Hemoperfusion adverse effects
Humans
Lupus Erythematosus, Systemic immunology
Male
Middle Aged
Prospective Studies
Sheep
Hemoperfusion methods
Immunosorbents
Lupus Erythematosus, Systemic therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0896-8411
- Volume :
- 11
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of autoimmunity
- Publication Type :
- Academic Journal
- Accession number :
- 9802935
- Full Text :
- https://doi.org/10.1006/jaut.1998.0229