Immunoadsorption and Plasma Exchange are Comparable in Anti-Neutrophil Cytoplasmic Antibodies or Anti-Glomerular Basement Membrane Removal Kinetics

Abstract

IntroductionApheresis allows the fast removal of auto-antibodies in anti-glomerular basement membrane (GBM) disease, and in severe ANCA-associated vasculitis. The CINEVAS study tested whether immunoadsorption (IA) allowed a faster removal of ANCA and/or anti-GBM antibodies than plasma exchanges (PEx). MethodsCINEVAS was a prospective multicenter study comparing IA to PEx in consecutive patients with ANCA and/or anti-GBM vasculitides. The primary objective was the reduction rate in auto-antibody titers between the beginning of the first and the end of the seventh apheresis session. Secondary objectives were: number of sessions needed to obtain desired reduction rates; reduction rates of total immunoglobulin (Ig) levels; tolerance of sessions; and patients’ outcome. ResultsThe results of 38 patients (16 treated with IA and 22 with PEx), and 43 auto-antibodies, were analyzed. There was no difference in the reduction rates in auto-antibody titers over 7 sessions between IA and PEx (respectively 98% vs 96%, p=0.39). The numbers of sessions needed to obtain undetectable auto-antibodies, or 50%, 75% or 90% reductions, did not differ between techniques. Greater reduction rates of auto-antibodies were observed when plasma was separated by filtration compared to centrifugation, with IA and PEx. IA allowed a greater reduction in total IgG levels, and better preservation of total IgA and IgM levels than PEx. PEx sessions required higher volumes of plasma, IA sessions higher volumes of citrate; IA sessions were longer. ConclusionsImmunoadsorption and plasma exchange were comparable in ANCA or anti-GBM removal kinetics, despite a faster reduction in total IgG with IA.