IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long term observational study. Issue 7 (7th January 2005)

• Record Type: Journal Article
• Authors: Stummvoll, G H; Aringer, M; Smolen, J S; Schmaldienst, S; Jiménez-Boj, E; Hörl, W H; Graninger, W B; Derfler, K
• Is Part Of: Annals of the rheumatic diseases. Volume 64:Issue 7(2005)
• Page Start: 1015
• Page End: 1021
• Publication Date: 2005-01-07
• Subjects: ACE, angiotensin converting enzyme -- AT-II-Ra, angiotensin II receptor antagonist -- AZA, azathioprine -- dsDNA, double stranded DNA -- ECLAM, European consensus league activity measurement -- IAS, immunoadsorption -- IC, immune complex -- IVCP, intravenous cyclophosphamide -- MMF, mycophenolate mofetil -- SIS, SLE index score -- SLE, systemic lupus erythematosus -- SLEDAI, SLE Disease Activity Index -- SLICC/ACR, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index; systemic lupus erythematosus -- nephritis -- proteinuria -- immunoadsorption; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/ard.2004.029660
• Languages: English
• ISSNs: 0003-4967

Abstract

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. Conclusion: 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.