Immunoadsorption and plasmapheresis are equally efficacious as adjunctive therapies for severe lupus nephritis.
This was a prospective randomized controlled trial to evaluate the effects of immunoadsorption (IA) versus conventional PP (PP) as adjunctive therapy in the treatment of severe lupus nephritis (LN). Of 28 patients with biopsy-proven severe LN (ISN/RPS classes III or IV ± V), 14 underwent 36 sessions of PP and the other 41 sessions of IA in addition to our center's standard LN treatment protocol. Three patients in the PP group and 2 in the IA group experienced a transient, marked drop in platelets with the second session. Except for a higher pre treatment mean SLEDAI score in the PP group 17.4 ± 2.0 vs. 13.5 ± 4.8; p = 0.009 and a serum creatinine of 163 ± 7.9 vs. 81.7 ± 10.2; p = 0.33, there were no other baseline differences. Some differences did exist between the two therapies in the immediate post-treatment phase, at 1 and 3 months. Three in IA relapsed, none of PP in third months, whereas two patients relapsed in the PP and none of IA cohorts at 6 months. However, most of these parameters did not differ by 6 months. The pre- and post-therapy SLEDAI scores remained different 12.4 ± 4.5 vs. 9 ± 4; p = 0.04 at 1 month, and at 3 month 13.5 ± 4.7 vs. 7.7 ± 1.1; p = 0.012 but not at 6 months. We conclude that IA and PP were equally well tolerated and efficacious as adjunctive therapy for severe LN.
Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. Electronic address: cyloo@gmail.com.
Chee-Yean
CY
Loo
Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. Electronic address: drobiwan@gmail.com.
Mohd Shahrir
MS
Mohamed Said
Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. Electronic address: rozita@gmail.com.
Rozita
R
Mohd
Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. Electronic address: halimgafor@gmail.com.
Abdul Halim
AH
Abdul Gafor
Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. Electronic address: drbulat@gmail.com.
Rashidi
R
Saidin
Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. Electronic address: norma@gmail.com.
Norma Abdul
NA
Halim
Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. Electronic address: kwichua@gmail.com.
Mei Kwi
MK
Chua
Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia. Electronic address: norellakong@gmail.com.
Norella C T
NCT
Kong
D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques; D008181:Lupus Nephritis / Q000628:therapy*; D008297:Male; D010956:Plasmapheresis; D010976:Platelet Count; D012709:Serum Albumin; D016896:Treatment Outcome; D055815:Young Adult
D012709:Serum Albumin; D003404:Creatinine