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FRI0390 Therapeutic Plasma Exchange (TPE) for Refractory Autoimmune Diseases: Report of 60 Cases
  1. O. Karadag1,
  2. A. Soyuoz1,
  3. U. Kalyoncu1,
  4. T. Karaagac2,
  5. L. Kilic1,
  6. S. Kiraz1,
  7. O. Ozcebe2,
  8. I. Ertenli1
  1. 1Department of Rheumatology
  2. 2Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey

Abstract

Background Therapeutic Plasma Exchange (TPE) is an effective therapeutic option for treating serious manifestations of systemic autoimmune diseases. More data about real life experience regarding outcomes of those patients are required.

Objectives This study is aimed to investigate the main demographic and clinical characteristics as well as the outcome of patients with systemic autoimmune diseases treated with TPE at an university hospital.

Methods Patients treated with TPE between 2002-2013 were included into the study. Indications for TPE, complications and outcomes were obtained from hospital records.

Results A total of 60 patients (Female/male: 43/17) were treated with TPE. Mean age at the time of 41.0±16.5 (range: 15-73 years). Twenty-one (35.0%) patients had SLE, 14 (23.4%) patients had patients had vasculitis, 6 patients had Sjogren syndrome, 4 patients had dermato/polimyositis, 3 patients had primary antiphospholipide syndrome, 12 patients with other diagnosis. Indications for TPE were hematologic (28.4%), neurologic (28.3%), pulmonary (20.0%) and renal failure (23.4%), myopathy (5.0%), hepatic (5.0%) and dermatologic (3.4%) causes. In 9 (15%) of patients TPE had performed in case of concomitant leucopenia or infection. Fifteen of the patients (25%) had TPE required disease involvement as presenting feature. All patients were receiving corticosteroids at varying doses and all received a concomitant immunosuppressive drug.

Outcome analysis had been done in 55 (91.6%) of patients. Totally 20 (33.3%) of patients had been died (17 of them during first treatment course, 3 of them after discharge from hospital). More than half of the patients with pulmonary (57.9%) and renal (63.6%) cause as TPE indication had been died whereas in neurologic and hematologic causes mortality were lower (26.7% and 18.8%, respectively).

The median application regimen of TPE was 6 (range 2-33) sessions with alternate days. In 32.3% of patients TPE had been performed in more than 10 times. The major adverse events of TPE were occurred in 14 (23.3%) of patients (catheter related problems 6 patients, hypotension 3 patients, 1 catheter infection, 2 thrombocytopenia). One patient had died due to atrial fibrillation and myocardial infarction periprocedural period.

Conclusions TPE is an effective therapeutic option for treating serious manifestations of systemic autoimmune diseases with less adverse events. TPE could be a valid option for those with refractory disease to conventional treatments and concomitant infection and/or leucopenia. Patients with pulmonary and renal indications had increased mortality compared to patients with hematologic and neurologic indications

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.4876

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