Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity
Systemic lupus erythematosus (SLE) is characterized by pathogenic autoantibodies, which can be removed by extracorporeal procedures. While previous studies have shown short-term efficacy of immunoadsorption (IAS) in SLE, no information on long-term benefit and safety is available. IAS was offered to...
Gespeichert in:
| Veröffentlicht in: | Nephrology, dialysis, transplantation dialysis, transplantation, 2012-02, Vol.27 (2), p.618-626 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 626 |
|---|---|
| container_issue | 2 |
| container_start_page | 618 |
| container_title | Nephrology, dialysis, transplantation |
| container_volume | 27 |
| creator | STUMMVOLL, Georg H SCHMALDIENST, Sabine SMOLEN, Josef S DERFLER, Kurt BIESENBACH, Peter |
| description | Systemic lupus erythematosus (SLE) is characterized by pathogenic autoantibodies, which can be removed by extracorporeal procedures. While previous studies have shown short-term efficacy of immunoadsorption (IAS) in SLE, no information on long-term benefit and safety is available.
IAS was offered to patients with highly active renal disease when conventional therapy had failed. Eleven patients entered the prolonged IAS programme and were followed for up to 10 years (mean 6.4 ± 3.5). Efficacy of IAS was determined by reduction in proteinuria (primary outcome), global disease activity [SLE Disease Activity Index (SLEDAI)] and anti-double-stranded DNA (anti-dsDNA) levels (secondary outcomes). Full/partial remission was defined as ≤ 0.5/≤ 1.0 g/day for proteinuria, ≤ 5/≤ 8 for SLEDAI and ≤ 25/≤ 50 IU/mL for anti-dsDNA levels. We further assessed flares, infections, malignancies and procedure-related adverse events.
Short-term IAS (≤ 1 year) resulted in a significant reduction of proteinuria (9.2 ± 3.7 to 2.3 ± 2.4, P = 0.0001), disease activity (SLEDAI 19 ± 8 to 4 ± 2, P = 0.0004) and dsDNA levels (168 ± 205 to 45 ± 34, P = 0.001). In patients without remission after 1 year (n = 5), prolonged IAS decreased proteinuria from 4.3 ± 2.4 to 0.5 ± 0.4 g/day, P = 0.02. At the end of observation, complete remission in proteinuria was achieved in seven patients (64%) and partial remission in two (18%) additional patients. One patient flared and was discontinued; in all other patients, disease activity and anti-dsDNA stabilized at remission levels. Flares (0.28 ± 0.30) and infections (0.66 ± 0.70 per patient/year) were relatively uncommon; no malignancies, anaphylactic or orthostatic adverse events were observed.
IAS is effective in short-term use but prolonged IAS can provide additional therapeutic benefit while showing an acceptable safety profile. The vast majority of initially therapy-refractory patients met the remission criteria at the end of observation. |
| doi_str_mv | 10.1093/ndt/gfr239 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_921145840</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>921145840</sourcerecordid><originalsourceid>FETCH-LOGICAL-c418t-c0609b0d75df594417d2e01a47b78779f74f71a954ae68229c31f6edc8f4d4973</originalsourceid><addsrcrecordid>eNpF0M1O3DAUBWCrApVh2k0fAHmD2iIFfBMnjtkhRAFpJBa068jxz9TIcVJfB4k-fYNmCqu7OJ-Org4hX4CdA5PVRTT5YutSWckPZAW8YUVZtfUBWS0hFKxm8ogcIz4xxmQpxEdyVEIDAmSzImEzTzPSaKffyWePl3RKYxjj1hrqh2GOozI4pin7MdJv91eP32myZtYWX2G2Ps7JK6qioZhV74P_u0TbMPYqUOPRKrRU6eyffX75RA6dCmg_7--a_Ppx8_P6rtg83N5fX20KzaHNhWYNkz0zojaulpyDMKVloLjoRSuEdII7AUrWXNmmLUupK3CNNbp13HApqjX5uutdXvwzW8zd4FHbEFS044ydLAF43XK2yLOd1GlETNZ1U_KDSi8dsO513G4Zt9uNu-CTfe3cD9a80f9rLuB0DxRqFVxSUXt8d7VoQIKs_gFaKYSX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>921145840</pqid></control><display><type>article</type><title>Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>STUMMVOLL, Georg H ; SCHMALDIENST, Sabine ; SMOLEN, Josef S ; DERFLER, Kurt ; BIESENBACH, Peter</creator><creatorcontrib>STUMMVOLL, Georg H ; SCHMALDIENST, Sabine ; SMOLEN, Josef S ; DERFLER, Kurt ; BIESENBACH, Peter</creatorcontrib><description>Systemic lupus erythematosus (SLE) is characterized by pathogenic autoantibodies, which can be removed by extracorporeal procedures. While previous studies have shown short-term efficacy of immunoadsorption (IAS) in SLE, no information on long-term benefit and safety is available.
IAS was offered to patients with highly active renal disease when conventional therapy had failed. Eleven patients entered the prolonged IAS programme and were followed for up to 10 years (mean 6.4 ± 3.5). Efficacy of IAS was determined by reduction in proteinuria (primary outcome), global disease activity [SLE Disease Activity Index (SLEDAI)] and anti-double-stranded DNA (anti-dsDNA) levels (secondary outcomes). Full/partial remission was defined as ≤ 0.5/≤ 1.0 g/day for proteinuria, ≤ 5/≤ 8 for SLEDAI and ≤ 25/≤ 50 IU/mL for anti-dsDNA levels. We further assessed flares, infections, malignancies and procedure-related adverse events.
Short-term IAS (≤ 1 year) resulted in a significant reduction of proteinuria (9.2 ± 3.7 to 2.3 ± 2.4, P = 0.0001), disease activity (SLEDAI 19 ± 8 to 4 ± 2, P = 0.0004) and dsDNA levels (168 ± 205 to 45 ± 34, P = 0.001). In patients without remission after 1 year (n = 5), prolonged IAS decreased proteinuria from 4.3 ± 2.4 to 0.5 ± 0.4 g/day, P = 0.02. At the end of observation, complete remission in proteinuria was achieved in seven patients (64%) and partial remission in two (18%) additional patients. One patient flared and was discontinued; in all other patients, disease activity and anti-dsDNA stabilized at remission levels. Flares (0.28 ± 0.30) and infections (0.66 ± 0.70 per patient/year) were relatively uncommon; no malignancies, anaphylactic or orthostatic adverse events were observed.
IAS is effective in short-term use but prolonged IAS can provide additional therapeutic benefit while showing an acceptable safety profile. The vast majority of initially therapy-refractory patients met the remission criteria at the end of observation.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfr239</identifier><identifier>PMID: 21617196</identifier><identifier>CODEN: NDTREA</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood Component Removal - methods ; Cohort Studies ; Emergency and intensive care: renal failure. Dialysis management ; Female ; Follow-Up Studies ; Humans ; Immunosorbent Techniques ; Immunosuppressive Agents - therapeutic use ; Intensive care medicine ; Kidney Function Tests ; Lupus Nephritis - diagnosis ; Lupus Nephritis - immunology ; Lupus Nephritis - therapy ; Male ; Medical sciences ; Prospective Studies ; Proteinuria - prevention & control ; Risk Assessment ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Severity of Illness Index ; Time Factors ; Treatment Outcome</subject><ispartof>Nephrology, dialysis, transplantation, 2012-02, Vol.27 (2), p.618-626</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c418t-c0609b0d75df594417d2e01a47b78779f74f71a954ae68229c31f6edc8f4d4973</citedby><cites>FETCH-LOGICAL-c418t-c0609b0d75df594417d2e01a47b78779f74f71a954ae68229c31f6edc8f4d4973</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25761919$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21617196$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>STUMMVOLL, Georg H</creatorcontrib><creatorcontrib>SCHMALDIENST, Sabine</creatorcontrib><creatorcontrib>SMOLEN, Josef S</creatorcontrib><creatorcontrib>DERFLER, Kurt</creatorcontrib><creatorcontrib>BIESENBACH, Peter</creatorcontrib><title>Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>Systemic lupus erythematosus (SLE) is characterized by pathogenic autoantibodies, which can be removed by extracorporeal procedures. While previous studies have shown short-term efficacy of immunoadsorption (IAS) in SLE, no information on long-term benefit and safety is available.
IAS was offered to patients with highly active renal disease when conventional therapy had failed. Eleven patients entered the prolonged IAS programme and were followed for up to 10 years (mean 6.4 ± 3.5). Efficacy of IAS was determined by reduction in proteinuria (primary outcome), global disease activity [SLE Disease Activity Index (SLEDAI)] and anti-double-stranded DNA (anti-dsDNA) levels (secondary outcomes). Full/partial remission was defined as ≤ 0.5/≤ 1.0 g/day for proteinuria, ≤ 5/≤ 8 for SLEDAI and ≤ 25/≤ 50 IU/mL for anti-dsDNA levels. We further assessed flares, infections, malignancies and procedure-related adverse events.
Short-term IAS (≤ 1 year) resulted in a significant reduction of proteinuria (9.2 ± 3.7 to 2.3 ± 2.4, P = 0.0001), disease activity (SLEDAI 19 ± 8 to 4 ± 2, P = 0.0004) and dsDNA levels (168 ± 205 to 45 ± 34, P = 0.001). In patients without remission after 1 year (n = 5), prolonged IAS decreased proteinuria from 4.3 ± 2.4 to 0.5 ± 0.4 g/day, P = 0.02. At the end of observation, complete remission in proteinuria was achieved in seven patients (64%) and partial remission in two (18%) additional patients. One patient flared and was discontinued; in all other patients, disease activity and anti-dsDNA stabilized at remission levels. Flares (0.28 ± 0.30) and infections (0.66 ± 0.70 per patient/year) were relatively uncommon; no malignancies, anaphylactic or orthostatic adverse events were observed.
IAS is effective in short-term use but prolonged IAS can provide additional therapeutic benefit while showing an acceptable safety profile. The vast majority of initially therapy-refractory patients met the remission criteria at the end of observation.</description><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood Component Removal - methods</subject><subject>Cohort Studies</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Immunosorbent Techniques</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Intensive care medicine</subject><subject>Kidney Function Tests</subject><subject>Lupus Nephritis - diagnosis</subject><subject>Lupus Nephritis - immunology</subject><subject>Lupus Nephritis - therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Prospective Studies</subject><subject>Proteinuria - prevention & control</subject><subject>Risk Assessment</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpF0M1O3DAUBWCrApVh2k0fAHmD2iIFfBMnjtkhRAFpJBa068jxz9TIcVJfB4k-fYNmCqu7OJ-Org4hX4CdA5PVRTT5YutSWckPZAW8YUVZtfUBWS0hFKxm8ogcIz4xxmQpxEdyVEIDAmSzImEzTzPSaKffyWePl3RKYxjj1hrqh2GOozI4pin7MdJv91eP32myZtYWX2G2Ps7JK6qioZhV74P_u0TbMPYqUOPRKrRU6eyffX75RA6dCmg_7--a_Ppx8_P6rtg83N5fX20KzaHNhWYNkz0zojaulpyDMKVloLjoRSuEdII7AUrWXNmmLUupK3CNNbp13HApqjX5uutdXvwzW8zd4FHbEFS044ydLAF43XK2yLOd1GlETNZ1U_KDSi8dsO513G4Zt9uNu-CTfe3cD9a80f9rLuB0DxRqFVxSUXt8d7VoQIKs_gFaKYSX</recordid><startdate>20120201</startdate><enddate>20120201</enddate><creator>STUMMVOLL, Georg H</creator><creator>SCHMALDIENST, Sabine</creator><creator>SMOLEN, Josef S</creator><creator>DERFLER, Kurt</creator><creator>BIESENBACH, Peter</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120201</creationdate><title>Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity</title><author>STUMMVOLL, Georg H ; SCHMALDIENST, Sabine ; SMOLEN, Josef S ; DERFLER, Kurt ; BIESENBACH, Peter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c418t-c0609b0d75df594417d2e01a47b78779f74f71a954ae68229c31f6edc8f4d4973</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood Component Removal - methods</topic><topic>Cohort Studies</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Immunosorbent Techniques</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Intensive care medicine</topic><topic>Kidney Function Tests</topic><topic>Lupus Nephritis - diagnosis</topic><topic>Lupus Nephritis - immunology</topic><topic>Lupus Nephritis - therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Prospective Studies</topic><topic>Proteinuria - prevention & control</topic><topic>Risk Assessment</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>STUMMVOLL, Georg H</creatorcontrib><creatorcontrib>SCHMALDIENST, Sabine</creatorcontrib><creatorcontrib>SMOLEN, Josef S</creatorcontrib><creatorcontrib>DERFLER, Kurt</creatorcontrib><creatorcontrib>BIESENBACH, Peter</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>STUMMVOLL, Georg H</au><au>SCHMALDIENST, Sabine</au><au>SMOLEN, Josef S</au><au>DERFLER, Kurt</au><au>BIESENBACH, Peter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol Dial Transplant</addtitle><date>2012-02-01</date><risdate>2012</risdate><volume>27</volume><issue>2</issue><spage>618</spage><epage>626</epage><pages>618-626</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><coden>NDTREA</coden><abstract>Systemic lupus erythematosus (SLE) is characterized by pathogenic autoantibodies, which can be removed by extracorporeal procedures. While previous studies have shown short-term efficacy of immunoadsorption (IAS) in SLE, no information on long-term benefit and safety is available.
IAS was offered to patients with highly active renal disease when conventional therapy had failed. Eleven patients entered the prolonged IAS programme and were followed for up to 10 years (mean 6.4 ± 3.5). Efficacy of IAS was determined by reduction in proteinuria (primary outcome), global disease activity [SLE Disease Activity Index (SLEDAI)] and anti-double-stranded DNA (anti-dsDNA) levels (secondary outcomes). Full/partial remission was defined as ≤ 0.5/≤ 1.0 g/day for proteinuria, ≤ 5/≤ 8 for SLEDAI and ≤ 25/≤ 50 IU/mL for anti-dsDNA levels. We further assessed flares, infections, malignancies and procedure-related adverse events.
Short-term IAS (≤ 1 year) resulted in a significant reduction of proteinuria (9.2 ± 3.7 to 2.3 ± 2.4, P = 0.0001), disease activity (SLEDAI 19 ± 8 to 4 ± 2, P = 0.0004) and dsDNA levels (168 ± 205 to 45 ± 34, P = 0.001). In patients without remission after 1 year (n = 5), prolonged IAS decreased proteinuria from 4.3 ± 2.4 to 0.5 ± 0.4 g/day, P = 0.02. At the end of observation, complete remission in proteinuria was achieved in seven patients (64%) and partial remission in two (18%) additional patients. One patient flared and was discontinued; in all other patients, disease activity and anti-dsDNA stabilized at remission levels. Flares (0.28 ± 0.30) and infections (0.66 ± 0.70 per patient/year) were relatively uncommon; no malignancies, anaphylactic or orthostatic adverse events were observed.
IAS is effective in short-term use but prolonged IAS can provide additional therapeutic benefit while showing an acceptable safety profile. The vast majority of initially therapy-refractory patients met the remission criteria at the end of observation.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>21617196</pmid><doi>10.1093/ndt/gfr239</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0931-0509 |
| ispartof | Nephrology, dialysis, transplantation, 2012-02, Vol.27 (2), p.618-626 |
| issn | 0931-0509 1460-2385 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_921145840 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood Component Removal - methods Cohort Studies Emergency and intensive care: renal failure. Dialysis management Female Follow-Up Studies Humans Immunosorbent Techniques Immunosuppressive Agents - therapeutic use Intensive care medicine Kidney Function Tests Lupus Nephritis - diagnosis Lupus Nephritis - immunology Lupus Nephritis - therapy Male Medical sciences Prospective Studies Proteinuria - prevention & control Risk Assessment Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Severity of Illness Index Time Factors Treatment Outcome |
| title | Lupus nephritis: prolonged immunoadsorption (IAS) reduces proteinuria and stabilizes global disease activity |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T10%3A33%3A12IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Lupus%20nephritis:%20prolonged%20immunoadsorption%20(IAS)%20reduces%20proteinuria%20and%20stabilizes%20global%20disease%20activity&rft.jtitle=Nephrology,%20dialysis,%20transplantation&rft.au=STUMMVOLL,%20Georg%20H&rft.date=2012-02-01&rft.volume=27&rft.issue=2&rft.spage=618&rft.epage=626&rft.pages=618-626&rft.issn=0931-0509&rft.eissn=1460-2385&rft.coden=NDTREA&rft_id=info:doi/10.1093/ndt/gfr239&rft_dat=%3Cproquest_cross%3E921145840%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=921145840&rft_id=info:pmid/21617196&rfr_iscdi=true |