Abstract
This was an exploratory analysis comparing the safety and efficacy of immunoadsorption (IAS) combination therapy in severe systemic lupus erythematosus (SLE) receiving corticosteroid pulse and immunosuppressant treatment. Patients enrolled all had predominant organ involvement including proteinuria, thrombocytopenia, pericardial effusion, and cerebral involvement requiring corticosteroid pulse treatment. Fifty-two patients in study group received IAS plus corticosteroid and cyclophosphamide treatment. Fifty-two patients in non-IAS group received corticosteroid and cyclophosphamide treatment. Outcome measurement included C3, dsDNA, AnuA, and SLE disease activity index (SLEDAI) 2k score and in particular cases, proteinuria quantification and platelet count. Disease activity dropped significantly in both groups. Improvement of disease activity markers was more significant in study group than that in non-IAS group. The lower dosage of steroid in study group suggested the steroid-sparing effect of IAS. No severe adverse effect occurred during IAS. Our study suggested IAS as an additional therapy to steroid pulse and immunosuppressant in treating severe SLE.
Similar content being viewed by others
References
Wener MH (2007) Immune complexes in systemic lupus erythematosus. In: Tsokos GC, Gordon C, Smolen JS (eds) Systemic lupus erythematosus, 1st edn. Mosby, Philadelphia, pp 214–224
Hershko AY, Naparstek Y (2005) Removal of pathogenic autoantibodies by immunoadsorption. Ann N Y Acad Sci 1051:635–646, PubMed: 16127004
Stummvoll GH (2011) Immunoadsorption (IAS) for systemic lupus erythematosus. Lupus 20(2):115–119, PubMed: 21303827
Loo CY, Mohamed Said MS, Mohd R, Abdul Gafor AH, Saidin R, Halim NA et al (2010) Immunoadsorption and plasmapheresis are equally efficacious as adjunctive therapies for severe lupus nephritis. Transfus Apher Sci 43(3):335–340
Stummvoll GH, Schmaldienst S, Smolen JS, Derfler K, Biesenbach P (2012) Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity. Nephrol Dial Transplant 27(2):618–626, PubMed: 21617196
Stummvoll GH, Aringer M, Smolen JS, Schmaldienst S, Jiménez-Boj E, Hörl WH et al (2005) IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long term observational study. Ann Rheum Dis 64(7):1015–1021, PubMed: 15640267
Biesenbach P, Schmaldienst S, Smolen JS, Hörl WH, Derfler K, Stummvoll GH (2009) Immunoadsorption in SLE: three different high affinity columns are adequately effective in removing autoantibodies and controlling disease activity. Atheroscler Suppl 29; 10(5):114–121
Amital H, Heilweil-Harel M, Ulmansky R, Harlev M, Toubi E, Hershko A et al (2007) Antibodies against the VRT101 laminin epitope correlate with human SLE disease activity and can be removed by extracorporeal immunoadsorption. Rheumatology 46:1433–1437, PubMed: 17686790
Pfueller B, Wolbart K, Bruns A, Burmester GR, Hiepe F (2001) Successful treatment of patients with systemic lupus erythematosus by immunoadsorption with a C1q column: a pilot study. Arthritis Rheum 44(8):1962–1963, PubMed: 11508450
Berner B, Scheel AK, Schettler V, Hummel KM, Reuss-Borst MA, Müller GA et al (2001) Rapid improvement of SLE-specific cutaneous lesions by C1q immunoadsorption. Ann Rheum Dis 60(9):898–899, PubMed: 11534506
Funauchi M, Ikoma S, Enomoto H, Ohno M, Kinoshita K, Horiuchi A et al (1996) High-affinity anti-DNA antibody parallels clinical course of immunoadsorption therapy. Intern Med 35(5):367–372, PubMed: 8797048
Kinoshita M, Aotsuka S, Funahashi T, Tani N, Yokohari R (1989) Selective removal of anti-double-stranded DNA antibodies by immunoadsorption with dextran sulphate in a patient with systemic lupus erythematosus. Ann Rheum Dis 48(10):856–860, PubMed: 2479345
Sugimoto K, Yamaji K, Yang KS, Kanai Y, Tsuda H, Hashimoto H (2006) Immunoadsorption plasmapheresis using a phenylalanine column as an effective treatment for lupus nephritis. Ther Apher Dial 10(2):187–192, PubMed: 16684222
Gaubitz M, Seidel M, Kummer S, Schotte H, Perniok A, Domschke W et al (1998) Prospective randomized trial of two different immunoadsorbers in severe systemic lupus erythematosus. J Autoimmun 11:495–501, PubMed: 9802935
Schneider M, Berning T, Waldendorf M, Glaser J, Gerlach U (1990) Immunoadsorbent plasma perfusion in patients with systemic lupus erythematosus. J Rheumatol 17(7):900–907, PubMed: 2213756
Yamazaki Z, Idezuki Y, Inoue N, Yoshizawa H, Yamawaki N, Inagaki K et al (1989) Extracorporral imuunoadsorption with IM-PH or IM-TR column. Biomater Artif Cells Artif Organs 17(2):117–124, PubMed: 2673426
Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277, PubMed: 7138600
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725, PubMed: 9324032
Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR et al (2012) Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 64(8):2677–2686, PubMed: 22553077
Hahn BH, McMahon MA, Wilkinson A, Wallace WD, Daikh DI, Fitzgerald JD et al (2012) American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis. Arthritis Care Res (Hoboken) 64(6):797–808, PubMed: 22556106
Gladman DD, Ibañez D, Urowitz MB (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol 29(2):288–291, PubMed: 11838846
Badsha H, Kong KO, Lian TY, Chan SP, Edwards CJ, Chng HH (2002) Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications. Lupus 11(8):508–513, PubMed: 12220105
Kong KO, Badsha H, Lian TY, Edwards CJ, Chng HH (2004) Low-dose pulse methylprednisolone is an effective therapy for severe SLE flares. Lupus 13(3):212–213, PubMed: 15119552
Suzuki K (2000) The role of immunoadsorption using dextran-sulfate cellulose columns in the treatment of systemic lupus erythematosus. Ther Apher 4(3):239–243, PubMed: 10910027
Graninger M, Schmaldienst S, Derfler K, Graninger WB (2002) Immunoadsorption therapy (therasorb) in patients with severe lupus erythematosus. Acta Med Austriaca 29(1):26–29, PubMed: 11899750
Suzuki K, Hara M, Harigai M, Ishizuka T, Hirose T, Matsuki Y, Kawaguchi Y et al (1991) Continuous removal of anti-DNA antibody, using a new extracorporeal immunoadsorption system, in patients with systemic lupus erythematosus. Arthritis Rheum 34(12):1546–1552, PubMed: 1747139
Braun N, Jünger M, Klein R, Gutenberger S, Guagnin M, Risler T (2002) Dextran sulfate (Selesorb) plasma apheresis improves vascular changes in systemic lupus erythematosus. Ther Apher 6(6):471–477, PubMed: 12460414
Stefanutti C, Vivenzio A, Di Giacomo S, Mareri M, Ceccarelli F, Valesini G (2005) Cyclophosphamide and immunoadsorption apheresis treatment of lupus nephritis nonresponsive to drug therapy alone. BioDrugs 19(2):129–133, PubMed: 15807630
Palmer A, Cairns T, Dische F, Gluck G, Gjorstrup P, Parsons V et al (1991) Treatment of rapidly progressive glomerulonephritis by extracorporeal immunoadsorption, prednisolone and cyclophosphamide. Nephrol Dial Transplant 6(8):536–542, PubMed: 1956551
Schmaldienst S, Müllner M, Goldammer A, Spitzauer S, Banyai S, Hörl WH et al (2001) Intravenous immunoglobulin application following immunoadsorption: benefit or risk in patients with autoimmune diseases? Rheumatology (Oxford) 40(5):513–521
Takahashi S, Wada N, Harada K (2007) Immunoadsorbent apheresis eliminates pathogenic IgG in childhood lupus nephritis. Pediatr Int 49(6):817–821, PubMed: 18045278
Lhotta K, Würzner R, Rosenkranz AR, Beer R, Rudisch A, Neumair F et al (2004) Cerebral vasculitis in a patient with hereditary complete C4 deficiency and systemic lupus erythematosus. Lupus 13(2):139–141, PubMed: 14995009
Dittrich E, Schmaldienst S, Langer M, Jansen M, Hörl WH, Derfler K (2002) Immunoadsorption and plasma exchange in pregnancy. Kidney Blood Press Res 25(4):232–239, PubMed: 12424425
Stummvoll GH, Aringer M, Jansen M, Smolen JS, Derfler K, Graninger WB (2004) Immunoadsorption (IAS) as a rescue therapy in SLE: considerations on safety and efficacy. Wien Klin Wochenschr 116(21-22):716–724, PubMed: 15628641
Taniguchi Y, Yorioka N, Okushin S, Oda H, Usui K, Yamakido M (1995) Usefulness of immunoadsorption therapy for systemic lupus erythematosus associated with transverse myelitis. A case report. Int J Artif Organs 18(12):799–801, PubMed: 8964648
Hershko AY, Scheiman-Elazari A, Aamar S, Naparstek Y (2013) Extracorporeal immunoadsorption of antibodies against the VRT-101 laminin epitope in systemic lupus erythematosus: a feasibility evaluation study. Immunol Res 56(2-3):376–381, PubMed: 23584986
Kronbichler A, Frank R, Kirschfink M, Szilágyi Á, Csuka D, Prohászka Z et al (2014) Efficacy of eculizumab in a patient with immunoadsorption-dependent catastrophic antiphospholipid syndrome: a case report. Medicine (Baltimore) 93(26), e143, PubMed:25474424
Ross S, Benz K, Sauerstein K, Amann K, Dötsch J, Dittrich K (2012) Unexpected recovery from longterm renal failure in severe diffuse proliferative lupus nephritis. BMC Nephrol 13:81, PubMed: 2286727
Rech J, Hueber AJ, Kallert S, Requadt C, Kalden JR, Schulze-Koops H (2006) Immunoadsorption and CD20 antibody treatment in a patient with treatment resistant systemic lupus erythematosus and preterminal renal insufficiency. Ann Rheum Dis 65(4):552–553, PubMed: 16531554
Stummvoll GH, Julius U, Derfler K, Aringer M (2009) Immunoadsorption for systemic lupus erythematosus. Atheroscler Suppl 10(5):110–113, PubMed: 20129387
Hauser AC, Hauser L, Pabinger-Fasching I, Quehenberger P, Derfler K, Hörl WH (2005) The course of anticardiolipin antibody levels under immunoadsorption therapy. Am J Kidney Dis 46(3):446–454, PubMed: 16129206
Maeshima E, Yamada Y, Kodama N, Mune M, Yukawa S (1999) Successful pregnancy and delivery in a case of systemic lupus erythematosus treated with immunoadsorption therapy and cyclosporin A. Scand J Rheumatol 28(1):54–57, PubMed: 10092166
Schmaldienst S, Jansen M, Hollenstein U, Graninger W, Regele H, Hörl WH et al (2002) Treatment of systemic lupus erythematosus by immunoadsorption in a patient suffering from tuberculosis. Am J Kidney Dis 39:415–418, PubMed: 11840385
Acknowledgments
We thank the nursing team of the apheresis unit for the accurate and friendly support. This research was supported by a National grant (81301529).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
All patients signed informed consent. The study was approved by the local ethics committee.
Disclosures
None.
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(DOC 54 kb)
Rights and permissions
About this article
Cite this article
Huang, J., Song, G., Yin, Z. et al. Rapid reduction of antibodies and improvement of disease activity by immunoadsorption in Chinese patients with severe systemic lupus erythematosus. Clin Rheumatol 35, 2211–2218 (2016). https://doi.org/10.1007/s10067-016-3354-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-016-3354-2