Plasma exchange in systemic lupus erythematosus

Euler, H. H.; Zeuner, Rainald; Schroeder, Johann O.

doi:10.1016/0955-3886(96)00016-1

Cited by 6 publications

(3 citation statements)

References 133 publications

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“…One open question is the value of IAS as an additional tool in the treatment of critical organ failure in SLE (like in our patient 2): due to rare incidence and the multimorbidity of such patients, and the fact that several therapeutic options are being used simultaneously, controlled studies are unlikely to ever be performed despite the increasing number of positive experiences with apheresis techniques as described extensively by Euler (9).…”

Section: Discussionmentioning

confidence: 99%

Immunoadsorption Therapy (Therasorb) in Patients with Severe Lupus Erythematosus

et al. 2002

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Therapeutic removal of immune complexes and antibodies by plasmapheresis has been used in patients with systemic lupus erythematosus (SLE) since 1974. Modern methods of selective adsorption of immunoglobulins from the patient plasma (immunoadsorption, IAS) have been developed; they deserve to be investigated as a tool in the management of difficult cases of SLE. We report our experience in an uncontrolled series of five consecutive SLE patients, in whom cytotoxic immunosuppression was contraindicated or not sufficient to control the disease. Ig-Therasorb columns containing polyclonal sheep antihuman immunoglobulin antibodies were used for IAS for periods of 4 to 54 weeks. In order to prevent rebound autoantibody production, low doses of normal human immunoglobulin were substituted. Improvement in clinical and laboratory signs of disease activity was observed in all patients. In two patients the effect of cyclophosphamide therapy for lupus pneumonitis and lupus-associated thrombopenic purpura was consolidated. In three patients suffering from pancytopenia or lupus vasculitis, the use of cytotoxic substances could be avoided for more than a year. IAS seems to be a safe replacement of conventional plasmapheresis in difficult cases of severe lupus complications. Although controlled studies are lacking, this method may occupy a few important niches as an adjunct in managing immune complex mediated diseases.

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Section: Discussionmentioning

confidence: 99%

Immunoadsorption Therapy (Therasorb) in Patients with Severe Lupus Erythematosus

et al. 2002

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“…23,24 Given that our patient had a life-threatening skin manifestation and had not responded to pulse corticosteroids or IVIG, it was decided that plasma exchange was indicated. The only other report of a similar approach was the use of plasmapheresis in the patient described by Simsek et al 15 This case, like ours, had almost complete resolution of skin lesions.…”

Section: Discussionmentioning

confidence: 98%

Systemic Lupus Erythematosus Presenting as Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Baker

Cresce

Ameri

et al. 2014

JCR: Journal of Clinical Rheumatology

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Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN)-like lesions in acute cutaneous lupus erythematosus [LE]) are an unusual manifestation of systemic LE. We describe a patient with widespread vesiculobullous lesions diagnosed as SJS/TEN-like acute cutaneous LE as the initial presentation of systemic LE. Stevens-Johnson syndrome/TEN-like LE may be differentiated from other vesiculobullous lesions by factors including a history of recent LE exacerbation, photodistribution of lesions, lack of a precipitating infection or medication exposure, minimal mucosal involvement, a prolonged course, response steroid treatment, and histologic and immunofluorescence findings. It is paramount to identify SJS/TEN-like LE as this condition requires early and aggressive intervention. The optimal treatment approach for SJS/TEN-like LE is unclear, and although some case reports have shown glucocorticoids to be useful, there are also reports of cases in which additional measures, such as intravenous immunoglobulin and plasmapheresis, were required to achieve a response. Our patient's condition was refractory to high-dose corticosteroids and intravenous immunoglobulin but was successfully treated using plasma exchange. As such, this treatment may hold potential for improving the care of other patients with refractory SJS/TEN-like LE.

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“…PE were initially prescribed as an attempt to clear immune complexes. [23][24][25] They are also known to, contribute to improving the Adjunctive plasma exchanges to treat neuropsychiatric lupus P Bartolucci et al clearance of immune complexes bound to erythrocyte complement receptor type 1 (CD35). 26 In addition, PE participate in the elimination of circulating apoptotic antigens that can stimulate B-lymphocytes.…”

Section: Discussionmentioning

confidence: 98%

Adjunctive plasma exchanges to treat neuropsychiatric lupus: a retrospective study on 10 patients

Bartolucci

Bréchignac

Cohen

et al. 2007

Lupus

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Neuropsychiatric manifestations of systemic lupus erythematosus (NPSLE) are among the main causes of morbidity and mortality attributed to lupus activity. Conventional NPSLE treatment combines CS and immunosuppressants, but some symptoms do not respond. We retrospectively evaluated the adjunction of plasma exchanges (PE) to treat 13 NPSLE flares occurring in 10 patients (mean age, 30 years) between 1989 and 2002. NP manifestations were the first SLE symptoms for seven patients, with a mean of 3.2 NP manifestations/flare. All patients received CS and cyclophosphamide pulses. A mean of 15 PE/flare were performed. All patients improved within a mean of 3 (median: 2.5; range: 1.5-8) weeks thereafter. Complete remissions of 7/13 flares were obtained within a mean of 7 (median: 4; range: 2-22) weeks. Partial remissions were achieved for the remaining six flares, characterized by new NP manifestations during three and insufficient control of the others. Other SLE manifestations regressed for all patients with the mean European consensus lupus activity measurement score declining from pretreatment 6.9 to 1.2. A regimen combining CS, cyclophosphamide and PE is effective against severe NPSLE, with acceptable toxicity.

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Plasma exchange in systemic lupus erythematosus

Cited by 6 publications

References 133 publications

Immunoadsorption Therapy (Therasorb) in Patients with Severe Lupus Erythematosus

Immunoadsorption Therapy (Therasorb) in Patients with Severe Lupus Erythematosus

Systemic Lupus Erythematosus Presenting as Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Adjunctive plasma exchanges to treat neuropsychiatric lupus: a retrospective study on 10 patients

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