Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Lupus Nephritis: Decrease in Proteinuria and Sustained Stabilization of Disease Activity in Patients under Prolonged Immunoadsorption (IAS).
Stummvoll2, Georg H., Biesenbach1, Peter, Schmaldienst1, Sabine, Smolen3, Josef, Derfler1, Kurt
SLE is characterized by pathogenic autoantibodies and immune complexes which can effectively be removed by extracorporeal procedures such as IAS. After up to one year of IAS, we had previously observed a reduction of proteinuria, disease activity and pre-treatment autoantibody levels in highly active SLE with renal involvement. Antibody removal, however, does not block the formation of new autoantibodies. Thus, a high percentage of these patients underwent prolonged IAS (>1 yr for up to 10yrs) and are the focus of this report. We evaluated patients under prolonged IAS for sustainability or further improvement of the primary response to IAS (proteinuria, disease activity, anti-dsDNA-Abs) and for the number of flares, infections, adverse events and tumors.
Patients and Methods:
IAS therapy was started in highly active SLE patients with lupus nephritis (proteinuria 7.1±4.8 g/day, SIS 15±6, SLEDAI 20±8, anti-dsDNA 394±712 IU/ml) if i.v. CYC was contraindicated or ineffectual. 13 patients responding to initial IAS therapy were included into the prolonged IAS program, showing moderate disease activity at the start of the extension period (proteinuria 2.0±2.4, SIS 4±2, SLEDAI 3±2, anti-dsDNA 47±36 IU/ml). We defined the end of observation (EoO) upon either completion of 10 yrs of IAS therapy or by 1.1.2009.
During IAS, oral immunosuppression and ACE/ATII-inhibitors were kept constant, steroids were tapered as clinically feasible. IAS was performed with high affinity columns and the effective removal of serum Ig was monitored. Severe infections were defined as requiring i.v. therapy or hospitalization, flares according to the SELENA protocol.
Under prolonged IAS (mean observation period of 6.7±3.5 years), proteinuria further decreased from 2.0±2.4 g/d to 0.9±1.7g/d (p<0.05) at the EoO and Creatinine clearence increased to normal ranges in all patients. Disease activity and anti-dsDNA levels could be stabilized at low levels (SIS3±3, SLEDAI 3±4, anti-dsDNA 26±24 IU/ml at EoO).
Complete remission (proteinuria <0.5g/d, SIS/SLEDAI <=4, pre-treatment dsDNA <25 IU/ml) was achieved in 9 (69%) patients. One patient flared and was discontinued. Ten (77%) patients are still under IAS therapy at the EoO. In 2 patients, IAS was stopped because of a sustained response. Severe infections (0.1±0.3 per patient year) and severe flares (0.1±0.2 per patient year) were uncommon. There were no anaphylactic or orthostatic adverse events or tumors.
Prolonged IAS leads to stabilization of disease activity in moderately active SLE patients and can induce sustained remission in previously refractory SLE while showing an acceptable safety profile.
To cite this abstract, please use the following information:
Stummvoll, Georg H., Biesenbach, Peter, Schmaldienst, Sabine, Smolen, Josef, Derfler, Kurt; Lupus Nephritis: Decrease in Proteinuria and Sustained Stabilization of Disease Activity in Patients under Prolonged Immunoadsorption (IAS). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :469