Plasmapheresis in SLE

Abstract

SUMMARY AND CONCLUSIONS The growing number of anecdotal reports on the effect of plasmapheresis in patients with active SLE suggests that plasmapheresis, particularly in combination with cytotoxic drugs, merits further exploration as a therapeutic modality. The next step is the institution of carefully controlled, randomized studies in which combinations of drugs and plasmapheresis are compared with drug treatment alone in groups of patients with active disease. Such studies are now being initiated (Rock, 1981). Until the results have been analysed, it is reasonable to suggest that plasmapheresis might be considered as a potentially valuable adjunct in the treatment of patients with severe SLE when high doses of corticosteroids have failed to produce a response. The evidence so far available suggests that plasmapheresis alone may be followed by a hazardous rebound of both immunochemical and clinical activity. The best results at present have been reported from a combination of plasmapheresis and cyclophosphamide. Because of the many questions which still remain about the efficacy of plasmapheresis, its use should normally be restricted to institutions with the capacity for clinical investigation, and wherever possible patients should be admitted to controlled studies for the evaluation of this promising, but potentially hazardous, therapeutic innovation.