Plasma Exchange Therapy in Systemic Lupus Erythematosus

Abstract

The purpose of this study is to evaluate the effects of plasma exchange (PEx) in patients with SLE and to compare two methods of PEx with conventional continuous flow centrifugation (CF) and double filtration plasmapheresis (DFPP). In the latter procedure, two membrane filters with different pore sizes are applied to separate selectively large molecular fraction of plasma protein. 10 series of PEx (4 of 10 on CF and other 6 on DFPP) were performed in 7 patients who have fulfilled the ARA criteria of SLE. Series of PEx consisted of 3 to 8 exchanges by CF or DFPP, and 5 % albumin solution was used for substitution. From clinical viewpoint, several acute symptoms were immediately improved following PEx with both methods except nephrotic syndrome in 4 cases. In 4 patients with rapidly deterioration of renal function, clinical improvement was observed immediately after PEx. With reference to laboratory findings, there were significant decreases in immune complexes (IC), various autoantibodies, immunoglobulins and serum total protein after PEx. As to these data, there were no significant differences between both methods except for the quantity of albumin per series required to substitute (CF 356±118 vs. DFPP 198±61gm). Just before PEx, IC were detected in 8 of 10 series and PEx showed some effects in 7 of these 8 series. No serious adverse reaction was observed in both methods except three episodes of transient fever. Conclusion are obtained as follows: 1) PEx is effective to reduce symptoms immediately, but not effective for nephrotic syndrome secondary to lupus nephritis, 2) better result is highly expectable if pre-PEx IC is positive, 3) the advantage of DFPP is to be able to reduce an amount of albumin solution for substitution.