Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small-vessel vasculitis

Klemmer, Philip J.; Chalermskulrat, Worakij; Reif, Michael S.; Hogan, Susan L.; Henke, David C.; Falk, Ronald J.

doi:10.1053/j.ajkd.2003.08.015

Cited by 321 publications

(209 citation statements)

References 13 publications

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“…More recently, rituximab has been introduced as an alternative to cyclophosphamide (6,7). For patients with respiratory failure and severe renal disease, plasma exchange (PE) has been advocated as an adjunct, even though its therapeutic efficacy is not well supported by the literature (8)(9)(10)(11)(12). Moreover, the interpretation of the literature on DAH in AAV is complicated by the small size of reported cohorts (8,(10)(11)(12)(13)(14)(15), variable and unclear definitions of DAH (16,17), and insufficient description of respiratory failure and its predictors (9,17).…”

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confidence: 99%

Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: Predictors of Respiratory Failure and Clinical Outcomes

Cartin‐Ceba

Diaz-Caballero²,

Al-Qadi

et al. 2016

Arthritis & Rheumatology

108

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Objective. To identify predictors of respiratory failure and to evaluate the therapeutic efficacy of plasma exchange (PE) and of rituximab versus cyclophosphamide in a cohort of patients with diffuse alveolar hemorrhage (DAH) secondary to antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with or without respiratory failure.Methods. We performed a single-center historical cohort study of all consecutive patients with AAVassociated DAH who were evaluated over a 16-year period. Logistic regression models were developed to examine the predictive role of the baseline clinical characteristics for the development of respiratory failure, and for the effect of PE and remission induction therapy on the main outcome (complete remission at 6 months).Results. Seventy-three patients with DAH were identified, and 34 of them experienced respiratory failure. The degree of hypoxemia upon initial presentation, a higher percentage of neutrophils in the bronchoalveolar lavage fluid cell count, and higher C-reactive protein levels were independently associated with the development of respiratory failure. PE was not associated with achieving complete remission at 6 months, with an odds ratio (OR) of 0.49 (95% confidence interval [95% CI] 0.12-1.95) (P 5 0.32). Rituximab treatment was independently associated with achieving complete remission at 6 months (OR 6.45 [95% CI 1.78-29], P 5 0.003).Conclusion. Our findings indicate that the most important predictor of respiratory failure in patients with DAH secondary to AAV is the degree of hypoxemia upon presentation. No clear benefit of the addition of PE to standard remission induction therapy was demonstrated. Complete remission by 6 months was achieved at a higher rate with rituximab than with cyclophosphamide in patients with DAH secondary to AAV, including those needing mechanical ventilation.

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confidence: 99%

Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: Predictors of Respiratory Failure and Clinical Outcomes

Cartin‐Ceba

Diaz-Caballero²,

Al-Qadi

et al. 2016

Arthritis & Rheumatology

108

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“…Basierend auf einer retrospektiven Fallserie [122], wird ein Effekt von Plasmaseparation auch bei schwerer alveolärer Hämorrhagie angenommen (die mit einer hohen Mortalität und der Notwendigkeit intensivmedizinischer Behandlung assoziiert ist) [98,120]. Neuere Daten zeigen jedoch keinen eindeutigen Nutzen der Plasmaseparation bei alveolärer Hämorrhagie [28].…”

Section: Diagnostikunclassified

S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis

Schirmer

Moosig²

2017

Z Rheumatol

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“…In 2005, however, Yamagata et al suggested that plasma exchange did not work, reporting on a Japanese population of 370 patients, 90 % of whom had myeloperoxidase (MPO)-ANCA, 53 of whom were treated with plasmapheresis [19]. Klemmer et al [20] and Gallagher et al [21] retrospectively reviewed 14 and 20 patients, respectively, suggesting that plasma exchange worked. Arguments to support the efficacy of plasma exchange included the reasoning that ANCA are believed to be pathogenic, with some animal experimental data to support that belief [22]; plasma exchange removes those antibodies.…”

Section: Nonrandomized Data In Pulmonary Hemorrhage Due To Vasculitismentioning

confidence: 99%

Role of therapeutic plasmapheresis in ANCA-associated vasculitis

Walters

2015

Pediatr Nephrol

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Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small-vessel vasculitis

Cited by 321 publications

References 13 publications

Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: Predictors of Respiratory Failure and Clinical Outcomes

Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: Predictors of Respiratory Failure and Clinical Outcomes

S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis

Role of therapeutic plasmapheresis in ANCA-associated vasculitis

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