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. 2005 Jan 7;64(7):1015–1021. doi: 10.1136/ard.2004.029660

IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long term observational study

G Stummvoll 1, M Aringer 1, J Smolen 1, S Schmaldienst 1, E Jimenez-Boj 1, W Horl 1, W Graninger 1, K Derfler 1
PMCID: PMC1755551  PMID: 15640267

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.

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Figure 1.

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 Reduction of (A) proteinuria; (B) overall disease activity; and (C) pretreatment anti-dsDNA levels in patients undergoing extended IAS. In patients who were offered an extension of IAS, a significant reduction in all primary and secondary outcome parameters was achieved within 3 months of IAS and a further reduction occurred after 12 months of treatment. Data are shown at the start of IAS and after 3, 6, and 12 months of treatment. *p<0.05; **p<0.001.

Selected References

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