Immunoadsorption onto protein A induces remission in severe systemic lupus erythematosus.
BACKGROUND
Reduction of pathological autoantibodies and circulating immune complexes can be useful in the treatment of autoimmune disease. Plasmapheresis has been shown to reduce autoantibody levels in systemic lupus erythematosus (SLE), but its effect on patients' outcome was not better compared with conventional immunosuppression in the past.


OBJECTIVE
Immunoadsorption as a selective extracorporeal immunoglobulin elimination technique was evaluated as rescue therapy in patients suffering from SLE.


METHODS
Eight patients with severe, therapy-resistant SLE underwent immunoadsorption onto protein A sepharose without concomitant immunosuppressants.


RESULTS
Remission of the disease was achieved in seven patients. Therapy had to be stopped in one patient because of side-effects. The best results were obtained when immunoadsorption was carried out daily, without supplementary intravenous immunoglobulin therapy. Oral cyclophosphamide for 3-6 months during follow-up was used to suppress relapse. Autoantibodies and circulating immune complexes were effectively eliminated regardless of their IgG subclass.


CONCLUSIONS
Immunoadsorption onto protein A might be used as an extracorporeal treatment option in SLE when other therapies are ineffective.
Braun
N
N
Medizinische Universitätsklinik, Abteilungen Innere Medizin III, Tübingen, Germany.
Erley
C
C
Klein
R
R
Kötter
I
I
Saal
J
J
Risler
T
T
D000284:Administration, Oral; D000936:Antigen-Antibody Complex / Q000032:analysis; D001323:Autoantibodies / Q000032:analysis; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000276:immunology / Q000628:therapy*; D008297:Male; D012074:Remission Induction; D019233:Retreatment; D016879:Salvage Therapy; D013205:Staphylococcal Protein A / Q000276:immunology*; D016896:Treatment Outcome
D000936:Antigen-Antibody Complex; D001323:Autoantibodies; D007166:Immunosuppressive Agents; D013205:Staphylococcal Protein A; D003520:Cyclophosphamide