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Cyclosporine and Therapeutic Plasma Exchange in Treatment of Progressive Autoimmune Diseases
Author(s) -
Schiel Ralf,
Bambauer Rolf,
Latza Reinhard,
Klinkmann Jens
Publication year - 1997
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.1997.tb00512.x
Subject(s) - medicine , azathioprine , cyclophosphamide , antibody , anti nuclear antibody , immunosuppressive drug , autoimmune disease , drug , gastroenterology , therapeutic effect , immunology , disease , autoantibody , chemotherapy , pharmacology , transplantation
Despite treatment with intensive immunosup‐pressive drug regimens, the prognosis of patients suffering from severe progressive autoimmune diseases like systemic lupus erythematosus (SLE), nephrotic syndrome (NS), and Behqet's disease is poor. Side effects (infections and malignant tumors) often occur. In the present trial, 35 patients suffering from autoimmune diseases (SLE, n = 21; NS, n = 10; and Behqet's disease, n = 4) were treated for 3.7 ± 2.0 years with 2.5 ± 0.6 mg cyclosporine/kg body weightlday in addition to corticosteroids alone or in combination with azathioprine and/or cyclophosphamide. In active stages of the diseases with extremely high concentrations of anti‐ds‐DNA‐antibodies, antinuclear antibodies, circulating immunocomplexes, and reduced complement concentrations, therapeutic plasma exchange (TPE) has been applied. Compared with previous treatment mo dalities, significantly (p < 0.05) more effective and rapid reductions of the antibodies were reached. Clinical disorders improved within 1–6 weeks. All patients reported increased performance and a better quality of life. After 1–12 months, the previously required doses of immuno‐suppressive drugs and the frequency of TPE could be reduced by 40–100%. After 13.4 ± 11.8 months in 17 of 35 patients (8 with SLE, 5 with NS, 4 with Behqet's disease), cyclosporine was established as the monotherapy. No severe side effects were registered. In treating active stages of severe progressive autoimmune diseases and forms with persistent high antibody levels, the addition of TPE to conventional therapy was very effective, as observed in both clinical and laboratory parameters.