Abstract
Standard treatment for severe systemic lupus erythematosus (SLE) consists of corticosteroids and immunosuppressive drugs. A number of controlled studies purport to show that parallel application of plasmapheresis is no longer tenable since it imparts no additional benefit. Three indications for plasmapheresis in SLE appear to remain: (1) emergency intervention; (2) contraindication of cytotoxic drugs in severe SLE; and (3) so-called “synchronization”, which combines plasmapheresis with subsequent high-dose pulse cyclophosphamide and has achieved repeatedly long-term, treatment-free remission in severe SLE. Immunoadsorption, especially employing an anti-immunoglobulin adsorber, appears to represent a further useful technological advance. It is questionable whether photopheresis, lymphapheresis, and cascade filtration will have a role to play in the treatment of SLE. An additional indication for apheresis may be the new procedure of autologous transplantation of purged stem cells.
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