title: Efficacy of plasma exchange and immunoadsorption in systemic lupus erythematosus and antiphospholipid syndrome: A systematic review.
abstract: Extracorporeal treatments have been used since the 1970s in the management of systemic lupus erythematosus (SLE). A randomised controlled trial comparing the efficacy of standard of care (SOC) combined with plasma exchange against SOC alone in patients with lupus nephritis revealed no difference in terms of renal outcome. Subsequently, initial expectations have been dampened and further experience with plasma exchange is mainly limited to observational studies and single case reports. Beneficial effects have been reported in patients with refractory disease course or in pregnancy with prior complications due to SLE and antiphospholipid syndrome. A more specific form of extracorporeal treatment, immunoadsorption (IAS), has emerged as a valuable option in the treatment of SLE. In line with the plasma exchange experience, IAS seems to have beneficial effects in patients with refractory disease, contraindications to standard immunosuppression or during pregnancy. The mechanism IAS relates to autoantibody removal but for plasma exchange removal of activated complement components, coagulation factors, cytokines and microparticles may also be relevant. Both treatment forms have good safety profiles although reactions to blood product replacement in plasma exchange and procedure related complications such as bleeding or catheter-related infections have occurred. There is a need to more clearly define the clinical utility of plasma exchange and IAS in refractory lupus and APS subgroups.
authors: Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Department of Internal Medicine IV (Nephrology and Hypertension), Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Electronic address: andreas.kronbichler@i-med.ac.at.
authors: Andreas
authors: A
authors: Kronbichler
authors: Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom.
authors: Biljana
authors: B
authors: Brezina
authors: Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain.
authors: Luis F
authors: LF
authors: Quintana
authors: Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom.
authors: David R W
authors: DR
authors: Jayne
mesh_terms: D016736:Antiphospholipid Syndrome / Q000276:immunology* / Q000628:therapy*; D001323:Autoantibodies / Q000276:immunology; D006470:Hemorrhage; D006801:Humans; D007163:Immunosorbent Techniques; D007239:Infections / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000276:immunology* / Q000628:therapy*; D010951:Plasma Exchange
chemical_list: D001323:Autoantibodies
keywords: Antiphospholipid syndrome; Complement; Extracorporeal treatment; Immunoadsorption; Lupus nephritis; Plasma exchange; Plasmapheresis; Refractory SLE; Systemic lupus erythematosus