Arthritis und Rheuma 2005; 25(03): 136-140
DOI: 10.1055/s-0037-1618500
Innovationen auf dem Prüfstand
Schattauer GmbH

Separationsverfahren bei Autoimmunerkrankungen und rheumatischen Prozessen

Extracorporal therapy in autoimmune diseases and rheumatic processes
Jürgen Rech
1   Universität Erlangen-Nürnberg, Medizinische Klinik III
› Author Affiliations
Further Information

Publication History

Publication Date:
23 December 2017 (online)

Zusammenfassung

Neben den deutlich verbesserten Behandlungsmöglichkei-ten und der damit verbesserten Prognose von Autoimmunerkrankungen durch den Einsatz von neuen Immunsuppressiva und Biologicals (monoklonale Antikörper wie z. B. Anti-TNF-Therapie) waren bereits in den 70er-Jahren die Extrakorporalverfahren wie z. B. therapeutischer Plasma-austausch und Immunadsorption Hoffnungsträger, die in der Vergangenheit die Erwartungen in ihrer Wirkung und Anwendung nicht erfüllten. Seither wird der Einsatz von Ex-trakorporalverfahren in der Rheumatologie kontrovers dis-kutiert.

Die Weiterentwicklung der spezifischen Extrakorporalverfahren (Immunadsorption, Photopherese) gegebenenfalls zusammen mit beispielsweise Biologicals ist eine neue Grundlage für die Möglichkeit des Einsatzes in der Therapie von Autoimmunerkrankungen. Ein deutlich reduziertes Nebenwirkungsprofil der Extrakorporalverfahren trägt dazu wesentlich bei.

Summary

In addition to the dramatic improvement in available therapies, and consequently the improved prognosis of autoimmune diseases through the use of new immunosuppressive agents and, for instance, biologicals (such as monoclonal antibodies e.g. anti-TNF therapy), the hope for the role of extracorporal therapy (e.g. therapeutic plasma exchange and immunoadsorption) has lagged behind since the seventies. Since then, the therapeutic need for extracorporal therapy has been controversially discussed. With improved specific extracorporal therapies, e.g. immunoadsorption and photopheresis, and a possible combination with biologicals, it currently seems to be a new treatment optioninautoimmunediseases, than kstotherelatively few side effects associated with extracorporal therapy.

 
  • Literatur

  • 1 Abel JJ., Rowntree LC., Turner BB. Plasma removal with return of corpuscles. J Pharmacol Exp Ther 1914; 5: 621-41.
  • 2 Braun N., Kadar JG., Risler T. Therapeutic immunoadsorption – its role in clinical practice. Transfus Sci 1998; 19 (Suppl.) 65-9.
  • 3 Clark WF., Balfe JW., Cattran DC. et al Long-Term Plasma Exchange in Patients with Systemic Lupus Erythematosus and Diffuse Proliferative Glomerulonephritis. Plasma Ther Transfus Technol 1984; 5: 353-60.
  • 4 Derksen RH., Hene RJ., Kallenberg CG. et al Prospective multicentre trial on the short-term effects of plasma exchange versus cytotoxic drugs in steroid-resistant lupus nephritis. Netherlands Journal of Medicine 1988; 33: 168-77.
  • 5 Euler HH., Schroeder JO., Harten P., Zeuner RA., Gutschmidt HJ. Treatment-Free Remission In Severe Systemic Lupus Erythematosus Following Synchronization of Plasmapheresis with Subsequent Pulse Cyclophosphamide. Arthritis and Rheumatism 1994; 37 (12) 1784-94.
  • 6 Euler HH., Schroeder JO., Löffler H., Christophers E. Synchronization of plasmapheresis and pulse cyclophosphamide in pemphigus vulgaris. Arch dermatol 1987; 123: 1205-10.
  • 7 Felson DT., Anderson JJ., Boers M. et al The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum 1993; 36 (06) 729-40.
  • 8 Gaubitz M., Schneider KM. Immunoadsorption in systemic lupus erythematosus: different techniques and their current role in medical therapy. Therap Apher Dial 2003; 7 (02) 183-8.
  • 9 Hashimoto H., Tsuda H., Kanai Y., Kobayashi S. Selective Removal of Anti-DNA and Anticardiolipin Antibodies by Absorbent Plasmapheresis using Dextran Sulfate Columns in Patients with Systemic Lupus Erythematosus. The Journal of Rheumatology 1991; 18 (04) 545-51.
  • 10 Haupt WF., Rosenow F., van der Ven C., Birkmann C. Immunoadsorption in Guillain-Barre syndrome and myasthenia gravis. Ther Apher 2000; 4 (03) 195-7.
  • 11 Heald PW., Perez MI., Christensen I. et al. Photopheresis therapy of cutaneous T-cell lymphoma: the Yale-New Haven Hospital experience. Yale J Biol Med 1989; 62 (06) 629-38.
  • 12 Hiepe F., Pfuller B., Wolbart K. et al. A multifunctional ligand for a new immunoadsorption treatment. Ther Apher 1999; 3 (03) 246-51.
  • 13 Hughes GR. Plasma exchange (plasmapheresis). Agents Actions Suppl 1980; 7: 62-5.
  • 14 Jones JV., Cumming RH., Bucknell RC., Asplin CM. Plasmapheresis in the Management of Acute Systemic Lupus erythematosus. The Lancet 1976; 3: 709-11.
  • 15 Jones JV., Robinson MF., Parciany RK. et al Therapeutic Plasmapheresis in systemic lupus erythematosus. Arthritis and Rheumatism 1981; 24 (09) 1113-20.
  • 16 Lewis EJ., Hunsicker LG., Shu-Ping Lan. et al for the Lupus Nephritis Collaborative Study Group. A controlled Trial of Plasmapheresis Therapy in Severe Lupus Nephritis. The New England Journal of Medicine 1992; 326: 1373-9.
  • 17 Luftl M., Stauber A., Mainka A. et al Successful removal of pathogenic autoantibodies in pemphigus by immunoadsorption with a tryptophan-linked polyvinylalcohol adsorber. Br J Dermatol 2003; 149 (03) 598-605.
  • 18 Lupus Plasmapheresis Study Group (LPSG) Clark WF., Dau PC., Euler HH. et al. Plasmapheresis and Subsequent Pulse Cyclophosphamide Versus Pulse Cyclophosphamide Alone in Severe Lupus. Journal of Clinical Apheresis 1991; 6: 40-7.
  • 19 Mistry-Burchardi N., Schönermarck U., Samtleben W. Apheresis in Lupus Nephritis. Therapeutic Apheresis 2001; 5 (03) 161.
  • 20 Rech J., Wollenhaupt J., Kalden JR. et al. and the RA-1 Photopheresis Study Group. A phase II, MULTICENTER, Randomized Double-Blind, “Sham” pheresis-Controlled, study of Extracorporal photoimmune therapy (ECP) with UVADEX for the treatment of rheumatoid arthritis (RA) in Patients (pts) who have an inadequate response to disease-modifying antirheumatic Drugs (DMARDs) and biological agents; Abstract submitted EULAR. 2005
  • 21 Ruocco V., Astarita C., Pisani M. Plasmapheresis as an alternative or adjunctive therapy in problem cases of pemphigus. Dermatologica 1984; 168: 219-23.
  • 22 Schwab PJ., Fahey JL. Treatment of Waldenstrom`s macroglobulinemia by plasmapheresis. N Engl J Med 1960; 574-9.
  • 23 Skoog WA., Adams WS. Plasmapheresis in a case of Waldenstrom`s macroglobulemia (Abstract). J Clin Res 1959; 7: 96.
  • 24 Suzuki K., Hara M., Harigai M. et al. Continuous Removal of Anti-DNA Antibody, using a new extracorporal Immunadsorption System, in Patients with systemic lupus erythematosus. Arthritis and Rheumatism 1991; 34 (12) 1546-51.
  • 25 Toepfer M., Sitter T., Burchardt C. et al. Klinische Immunadsorption. Dtsch med Wschr 1999; 124: 461-5.
  • 26 Wallace DJ. Plasmapheresis in Rheumatic Diseases. Biomed Pharmacother 1986; 40 (08) 284-6.
  • 27 Wie N., Klippel JH., Huston DP. et al Randomized Trial of plasma Exchange in mild Systemic Lupus Erythematosus. The Lancet 1983; 1 (08) 17-21.