IgG Immunoadsorption May Improve Global Disease Activity in Systemic Lupus Erythematosus

Laurie Barclay, MD

July 15, 2005

July 15, 2005 — IgG immunoadsorption (IAS) can improve systemic lupus erythematosus (SLE), according to the results of a small study published in the July issue of the Annals of Rheumatic Disease.

"SLE treatment, in general, and immunosuppression, in particular, ultimately aims at interfering with autoantibody formation," write G.H. Stummvoll, from the University of Vienna in Austria, and colleagues. "In contrast with plasma exchange, IAS — or IgG apheresis — uses columns that bind human IgG. This allows for the specific and nearly complete clearance of circulating IgG and immune complexes (ICs), while neither removing other plasma proteins nor necessitating substitution with fresh frozen plasma or albumin."

In this long-term, observational study, 16 patients in whom cyclophosphamide was contraindicated or did not arrest progression of severe SLE and renal disease received IAS for three months. Patients who responded, defined as improving by at least 20% in two or more of the outcome measures, were offered an extension period of nine months.

Within three months, 14 patients responded, and 11 of these decided to continue IAS treatment. Mean proteinuria decreased from 6.7 ± 4.6 g per day at baseline to 4.3 ± 3.5 g per day at three months and to 2.9 ± 2.4 g per day at 12 months (P < .001), and anti-dsDNA decreased from 391 ± 647 IU per mL to 146 ± 218 IU per mL and to 53 ± 50 IU per mL at 3 and 12 months, respectively.

Disease activity improved independently of scoring instrument used from baseline to 3 and 12 months (P < .0001). Steroid dosage was tapered from 117 ± 159 mg per day at baseline to 29 ± 17 mg per day at three months, and to 9 ± 2 mg per day at 12 months. Although IAS was not associated with increased rate of infections, one patient died of septicemia after one month of treatment.

Study limitations include small sample size, uncontrolled design, and difficulty excluding conclusively a carryover effect of previous treatments.

"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," the authors write. "Patients receiving IAS did not appear to be more prone to adverse events and infections than expected given their rather high disease activity. Prospective controlled trials are warranted to determine conclusively the role of IAS in SLE treatment."

Ann Rheum Dis. 2005;64:1015-1021

Reviewed by Gary D. Vogin, MD

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