Immunoadsorption and plasmapheresis are equally efficacious as adjunctive therapies for severe lupus nephritis

Abstract

This was a prospective randomized controlled trial to evaluate the effects of immunoadsorption (IA) versus conventional PP (PP) as adjunctive therapy in the treatment of severe lupus nephritis (LN).Of 28 patients with biopsy-proven severe LN (ISN/RPS classes III or IV±V), 14 underwent 36 sessions of PP and the other 41 sessions of IA in addition to our center’s standard LN treatment protocol. Three patients in the PP group and 2 in the IA group experienced a transient, marked drop in platelets with the second session. Except for a higher pre treatment mean SLEDAI score in the PP group 17.4±2.0 vs. 13.5±4.8; p=0.009 and a serum creatinine of 163±7.9 vs. 81.7±10.2; p=0.33, there were no other baseline differences. Some differences did exist between the two therapies in the immediate post-treatment phase, at 1 and 3months. Three in IA relapsed, none of PP in third months, whereas two patients relapsed in the PP and none of IA cohorts at 6months. However, most of these parameters did not differ by 6months. The pre- and post-therapy SLEDAI scores remained different 12.4±4.5 vs. 9±4; p=0.04 at 1month, and at 3month 13.5±4.7 vs. 7.7±1.1; p=0.012 but not at 6months.We conclude that IA and PP were equally well tolerated and efficacious as adjunctive therapy for severe LN.