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Plasma exchanges for the treatment of severe systemic necrotizing vasculitides in clinical daily practice: Data from the French Vasculitis Study Group.

Abstract
The use of plasma exchanges (PLEX) in systemic necrotizing vasculitides (SNV) still need to be codified. To describe indications, efficacy and safety of PLEX for the treatment of SNV, we conducted a multicenter retrospective study on patients with ANCA-associated vasculitis (AAV) or non-viral polyarteritis nodosa (PAN) treated with PLEX. One hundred and fifty-two patients were included: GPA (n = 87), MPA (n = 56), EGPA (n = 4) and PAN (n = 5). PLEX were used for rapidly progressive glomerulonephritis (RPGN) in 126 cases (86%), alveolar hemorrhage in 64 cases (42%), and severe mononeuritis multiplex in 23 cases (15%). In patients with RPGN, there was a significant improvement in renal function compared to baseline value (P < 0.0001), the plateau being reached at month 3 after PLEX initiation, and estimated glomerular filtration rate improved especially as the number of PLEX increased. In patients with alveolar hemorrhage, mechanical ventilation was discontinued in all patients after a median time of 15 days. Patients treated for mononeuritis multiplex showed improvement of severe motor weakness. After a median follow of 22 months, 18 deaths (12%) were recorded, mainly in patients with RPGN and within the first 6 months. Incidence of end-stage renal disease and/or death was similar between groups of different baseline renal function, but was increased in MPO-ANCA compared to PR3-ANCA. Adverse events attributable to PLEX were recorded in 63%. No death occurred during PLEX. This large series describes indications, efficacy and safety of PLEX in daily practice. Randomized controlled studies are ongoing to define optimal indications, PLEX regimen and concomitant medications.
AuthorsGonzalo de Luna, Dominique Chauveau, Julien Aniort, Pierre-Louis Carron, Pierre Gobert, Alexandre Karras, Sylvain Marchand-Adam, François Maurier, Pierre-Yves Hatron, Alexandre Mania, Guillaume le Guenno, Stéphane Bally, Boris Bienvenu, Eric Cardineau, Tiphaine Goulenok, Noémie Jourde-Chiche, Maxime Samson, Antoine Huart, Jacques Pourrat, Aurélien Tiple, Olivier Aumaitre, Xavier Puéchal, Farhad Heshmati, Claire le Jeunne, Luc Mouthon, Loïc Guillevin, Benjamin Terrier, French Vasculitis Study Group (FVSG)
JournalJournal of autoimmunity (J Autoimmun) Vol. 65 Pg. 49-55 (Dec 2015) ISSN: 1095-9157 [Electronic] England
PMID26330347 (Publication Type: Journal Article, Multicenter Study)
CopyrightCopyright © 2015 Elsevier Ltd. All rights reserved.
Topics
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis (mortality, therapy)
  • Female
  • France (epidemiology)
  • Glomerular Filtration Rate
  • Glomerulonephritis (mortality, therapy)
  • Hemorrhage (mortality, therapy)
  • Humans
  • Incidence
  • Kidney Failure, Chronic (epidemiology)
  • Lung Diseases (mortality, therapy)
  • Male
  • Middle Aged
  • Mononeuropathies (therapy)
  • Plasma Exchange
  • Polyarteritis Nodosa (therapy)
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

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