Programmed immunoadsorption with regeneration of adsoption columns in the treatment of lupus nephritis
https://doi.org/10.14412/1996-7012-2020-3-111-116
Abstract
Programmed immunoadsorption (IA) with regeneration of adsoption columns is a promising and safe technique to treat lupus nephritis (LN) in case of ineffective immunosuppressive therapy and its severe adverse reactions. This technique makes it possible to control disease activity, to maintain kidney function, and to ensure a normal quality of life. Due to the reusability of IA columns, it is possible to remove any required amount of IgG and to reduce the cost of an extracorporeal procedure.
The paper describes a clinical case of 3-year prolonged IA in a female patient with systemic lupus erythematosus (SLE) and LN with the insufficient efficacy of drug therapy and related complications. Seventy IA sessions were performed during a follow-up period. Combined treatment with glucocorticoids, cytotoxic drugs, and IA resulted in improved clinical and laboratory parameters, lower SLE activity according to SELENA-SLEDAI scores, and better quality of life according to the SF-36 scale. No adverse reactions were recorded during IA sessions.
About the Authors
A. A. Sokolov
S.M. Kirov Medical Military Academy, Ministry of Defense of Russia
Russian Federation
Russian Federation
Aleksey Albertovich Sokolov
6, Academician Lebedev St., Saint Petersburg 194044
A. S. Manuilov
S.M. Kirov Medical Military Academy, Ministry of Defense of Russia
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
S. N. Bardakov
S.M. Kirov Medical Military Academy, Ministry of Defense of Russia
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
V. V. Tishko
S.M. Kirov Medical Military Academy, Ministry of Defense of Russia
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
A. N. Belskikh
S.M. Kirov Medical Military Academy, Ministry of Defense of Russia
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
O. Yu. Strelnikova
S.M. Kirov Medical Military Academy, Ministry of Defense of Russia
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
Russian Federation
6, Academician Lebedev St., Saint Petersburg 194044
T. V. Bulgakova
OOO «INVITRO SPb»
Russian Federation
18A, Blagodatnaya St., Saint Petersburg 196105
Russian Federation
18A, Blagodatnaya St., Saint Petersburg 196105
References
1. Nasonov EL, Nasonova VA, editors. Revmatologiya: natsional'noe rukovodstvo [Rheumatology. National guide]. Moscow: GEOTAR-Media; 2008. 720 p..
2. Boumpas DT. EULAR recommendations for lupus nephritis: balancing efficacy vs toxicity, pitfalls, and challenges. Proceedings of the VI-th EULAR Scientifically Endorsed Course on SLE. Pisa; 2013.
3. Panafidina TA, Popkova TV. General principles in the treatment of lupus nephritis with the prevention of cardiovascular events. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2018;12(4):4–8. (In Russ.).
4. Cervera R, Khamashta MA, Hughes GR. The Euro-lupus project: epidemiology of systemic lupus erythematosus in Europe. Lupus. 2009 Sep;18(10):869-74. doi: 10.1177/0961203309106831.
5. Padmanabhan A, Connelly-Smith L, Aqui N, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019 Jun;34(3):171-354. doi: 10.1002/jca.21705.
6. Bertsias GK, Tektonidou M, Amoura Z, et al.; European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association. Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012 Nov;71(11): 1771-82. doi: 10.1136/annrheumdis-2012201940.
7. Diseases to which Plasmapheresis can be applied under Health Insurance in Japan. http://www.kawasumi.jp/english/hp/medical/dfpp/.
8. Aseeva EA, Soloviev SK, Popkova TV, et al. Management of patients with systemic lupus erythematosus in real clinical practice. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2019; 57(2):191-196. (In Russ.).
9. Sokolov AA. Innovative extracorporeal technologies. Vrach. 2017;(12):24-6. (In Russ.).
10. Li M, Wang Y, Qiu Q, et al. Therapeutic effect of double-filtration plasmapheresis combined with methylprednisolone to treat diffuse proliferative lupus nephritis. J Clin Apher. 2016 Aug;31(4):375-80. doi: 10.1002/jca.21408.
11. Yamaji K, Kim YJ, Tsuda H, Takasaki Y. Long-term clinical outcomes of synchronized therapy with plasmapheresis and intravenous cyclophosphamide pulse therapy in the treatment of steroid-resistant lupus nephritis. Ther Apher Dial. 2008 Aug;12(4):298-305. doi: 10.1111/j.1744-9987.2008.00591.x.
12. Stefanutti C, Vivenzio A, Di Giacomo S, et al. Cyclophosphamide and immunoadsorption apheresis treatment of lupus nephritis nonresponsive to drug therapy alone. BioDrugs. 2005;19(2):129-33. doi: 10.2165/00063030200519020-00004.
13. Braun N, Erley C, Klein R, et al. Immunoadsorption onto protein A induces remission in severe systemic lupus erythematosus. Nephrol Dial Transplant. 2000 Sep; 15(9):1367-72. doi: 10.1093/ndt/15.9.1367.
14. Stummvoll GH, Schmaldienst S, Smolen JS, et al. Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity. Nephrol Dial Transplant. 2012 Feb;27(2):618-26. doi: 10.1093/ndt/gfr239.
15. Stummvoll GH, Aringer M, Smolen JS, et al. IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long term observational study. Ann Rheum Dis. 2005 Jul;64(7):1015-21. doi: 10.1136/ard.2004.029660. Epub 2005 Jan 7.
16. Vorobyeva LD, Aseeva EA, Solovyev SK, Glukhova SI. Selection of an optimal healthrelated quality of life questionnaire in patients with systemic lupus erythematosus. NauchnoPrakticheskaya Revmatologiya = Rheumatology Science and Practice. 2018;56(5):574-80. (In Russ.). doi: 10.14412/1995-4484-2018574-580
17. Novik AA, Ionova TI. Rukovodstvo po issledovaniyu kachestva zhizni v meditsine [Guidelines for Quality of Life Research in Medicine]. Saint-Petersburg: Neva; 2002. 320 p.
18. Bisaga GN, Bel'skikh AN, Kalinina NM, et al. Experience of the prolonged program extracorporeal hemocorrection at patients with secondary progressive multiple sclerosis. Nevrologicheskii vestnik. 2010;43(1):163–5. (In Russ.).
19. Chshieva MR, Sokolov AA, Danilichev VF, Knorring GYu. Extracorporeal hemocorrection in the complex treatment of patients with chronic relapsing uveitis. Voenno-meditsinskii zhurnal. 2011;(4):67–70. (In Russ.).
Review
For citations:
Sokolov AA, Manuilov AS, Bardakov SN, Tishko VV, Belskikh AN, Strelnikova OY, Bulgakova TV. Programmed immunoadsorption with regeneration of adsoption columns in the treatment of lupus nephritis. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2020;14(3):111-116. (In Russ.) https://doi.org/10.14412/1996-7012-2020-3-111-116
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