title: IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long term observational study.
abstract: OBJECTIVE
  To analyse the effects of rigorous immunoglobulin removal by immunoadsorption (IAS) on proteinuria (primary outcome variable), disease activity (SIS, SLEDAI, ECLAM), and autoantibodies to double stranded DNA (anti-dsDNA) in active systemic lupus erythematosus (SLE).
  
  
  METHODS
  16 patients with severe SLE and renal disease, in whom cyclophosphamide was contraindicated or failed to halt disease progression, were treated with IAS for 3 months. Patients achieving at least 20% improvement in two or more of the outcome measures were considered responders and offered a 9 months' extension period.
  
  
  RESULTS
  Within 3 months, 14 patients responded and 11 opted for an extension. Proteinuria decreased from 6.7 (4.6) g/day (mean (SD)) at baseline to 4.3 (3.5) g/day at 3 months and 2.9 (2.4) g/day at 12 months (p<0.001). From baseline to 3 and 12 months, disease activity improved independently of scoring by SIS (15 (5) to 5 (2) and to 5 (2), p<0.0001), SLEDAI (21 (7) to 5 (4) and to 5 (4), p<0.0001), or ECLAM (7 (2) to 2 (1) and to 3 (1), p<0.0001). Anti-dsDNA fell from 391 (647) IU/ml to 146 (218) and to 53 (50) IU/ml at 3 and 12 months, respectively. Steroids could be tapered from 117 (159) mg/day at baseline to 29 (17) mg/day at 3 months and 9 (2) mg/day at 12 months. IAS was not associated with an excess of infections. However, one patient died of septicaemia after 1 month of treatment.
  
  
  CONCLUSIONS
  In this negatively selected cohort of patients with SLE, IAS was associated with a significant response shown by reduced proteinuria, improved global disease activity, decreased anti-dsDNA, and lower glucocorticoid dosages, suggesting therapeutic benefit.
authors.affiliation: Department of Rheumatology, Internal Medicine III, University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Georg.Stummvoll@meduniwien.ac.at
authors.forename: G H
authors.initials: GH
authors.lastname: Stummvoll
authors.forename: M
authors.initials: M
authors.lastname: Aringer
authors.forename: J S
authors.initials: JS
authors.lastname: Smolen
authors.forename: S
authors.initials: S
authors.lastname: Schmaldienst
authors.forename: E
authors.initials: E
authors.lastname: Jiménez-Boj
authors.forename: W H
authors.initials: WH
authors.lastname: Hörl
authors.forename: W B
authors.initials: WB
authors.lastname: Graninger
authors.forename: K
authors.initials: K
authors.lastname: Derfler
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001379:Azathioprine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D008181:Lupus Nephritis / Q000188:drug therapy / Q000276:immunology / Q000628:therapy; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018579:Patient Selection; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine