A prospective study comparing tryptophan immunoadsorption with therapeutic plasma exchange for the treatment of chronic inflammatory demyelinating polyneuropathy*

Lieker, Ina; Slowinski, Torsten; Harms, Lutz; Hahn, Katrin; Klehmet, Juliane

doi:10.1002/jca.21546

Cited by 32 publications

(22 citation statements)

References 28 publications

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“…The authors reported a similar rate of clinical improvement and side effects, and this is in line with retrospective studies indicating that there is little difference between the two treatments. 65 Immunosuppression may be required particularly in atypical CIDP variants or in long-term cases, using agents such as azathioprine, mycophenolate mofetil or methotrexate, although evidence from randomised controlled trials is lacking for these agents. A randomised controlled study that evaluated the utility of fingolimod in CIDP did not show any beneficial effect and was stopped for futility.…”

Section: Treatmentmentioning

confidence: 99%

Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment

Lehmann

Burke

Kuwabara

2019

J Neurol Neurosurg Psychiatry

180

110

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Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated neuropathy typically characterised by symmetrical involvement, and proximal as well as distal muscle weakness (typical CIDP). However, there are several ‘atypical’ subtypes, such as multifocal acquired demyelinating sensory and motor neuropathy (Lewis-Sumner syndrome) and ‘distal acquired demyelinating symmetric neuropathy’, possibly having different immunopathogenesis and treatment responses. In the absence of diagnostic and pathogenetic biomarkers, diagnosis and treatment may be difficult, but recent progress has been made in the application of neuroimaging tools demonstrating nerve hypertrophy and in identifying subgroups of patients who harbour antibodies against nodal proteins such as neurofascin and contactin-1. Despite its relative rarity, CIDP represents a significant economic burden, mostly due to costly treatment with immunoglobulin. Recent studies have demonstrated the efficacy of subcutaneous as well as intravenous immunoglobulin as maintenance therapy, and newer immunomodulating drugs can be used in refractory cases. This review provides an overview focusing on advances over the past several years.

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Section: Treatmentmentioning

confidence: 99%

Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment

Lehmann

Burke

Kuwabara

2019

J Neurol Neurosurg Psychiatry

180

110

View full text Add to dashboard Cite

show abstract

“…It was found that four patients (44.4%) in the TPE group responded to treatment compared to six patients (66.7%) in the IA group. In the IA group, 100% of the patients had an improvement in their MRC sum scores and four patients out of six patients (66.7%) [162].…”

Section: Chronic Inflammatory Demyelinating Polyradiculoneuropathymentioning

confidence: 96%

Immunoadsorption Techniques and Its Current Role in the Intensive Care Unit

Hamilton¹,

Harris²,

Mitra³

2019

Aspects in Continuous Renal Replacement Therapy

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Immunoadsorption is an extracorporeal technique used for the removal of antibodies and molecules from the blood. A large number of different adsorbents are now available allowing for the non-selective removal of all subclasses of immunoglobulins such as IgG or more selective removal of disease specific molecules such as lipoprotein(a) and CRP. This selectivity, coupled with its highly efficient removal of the molecule, along with a favourable side-effect profile, has made immunoadsorption an attractive option in a range of autoimmune diseases. Here we discuss the mechanism and technique of immunoadsorption and review the current evidence and indications for its use, particularly in relation to sepsis.

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“…Immunoglobulins can be targeted for removal through binding to selected ligands on the backing matrix surface (membranes or beads) of the adsorption column (Table II). Although IA is effective for the treatment of pemphigus vulgaris 70,71 and CIDP, 72,73 IA systems are used less frequently than PLEX for the treatment of IgG autoantibody-mediated diseases, due to the availability and complexity of the procedure, and regulatory and economic differences between health care systems. 51 The American Society for Apheresis, the American Academy of Neurology, and other organizations have published guidelines and commentaries for PLEX and IA, 51,74,75 noting that side effects and complications of PLEX and IA mostly relate to the procedure itself.…”

Section: What Can We Learn From Other Conditions and Therapies? Procementioning

confidence: 99%

Targeting FcRn for immunomodulation: Benefits, risks, and practical considerations

Peter

Ochs

Cunningham‐Rundles

et al. 2020

Journal of Allergy and Clinical Immunology

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The neonatal fragment crystallizable (Fc) receptor (FcRn) functions as a recycling mechanism to prevent degradation and extend the half-life of IgG and albumin in the circulation. Several FcRn inhibitors selectively targeting IgG recycling are now moving rapidly toward clinical practice in neurology and hematology. These molecules accelerate the destruction of IgG, reducing pathogenic IgG and IgG immune complexes, with no anticipated effects on IgA, IgM, IgE, complement, plasma cells, B cells, or other cells of the innate or adaptive immune systems. FcRn inhibitors have potential for future use in a much wider variety of antibody-mediated autoimmune diseases. Given the imminent clinical use, potential for broader utility, and novel mechanism of action of FcRn inhibitors, here we review data from 4 main sources: (a) currently available activity, safety, and mechanism-of-action data from clinical trials of FcRn inhibitors; (b) other procedures and treatments that also remove IgG (plasma donation, plasma exchange, immunoadsorption); (c) diseases resulting in loss of IgG; and (d) primary immunodeficiencies with potential mechanistic similarities to those induced by FcRn inhibitors. These data have been evaluated to provide practical considerations for the assessment, monitoring, and reduction of any potential infection risk associated with FcRn inhibition, in addition to highlighting areas for future research.

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A prospective study comparing tryptophan immunoadsorption with therapeutic plasma exchange for the treatment of chronic inflammatory demyelinating polyneuropathy*

Abstract: The results of this pilot study suggest that IA is at least equally effective and safe compared to PE in CIDP patients.

Cited by 32 publications

References 28 publications

Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment

Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment

Immunoadsorption Techniques and Its Current Role in the Intensive Care Unit

Targeting FcRn for immunomodulation: Benefits, risks, and practical considerations

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