Therapeutic plasma exchange for the treatment of systemic sclerosis: A comprehensive review and analysis.
JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018;
3:132-152. [PMID:
35382237 PMCID:
PMC8892860 DOI:
10.1177/2397198318758606]
[Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/03/2018] [Indexed: 01/30/2023]
Abstract
Background:
Therapeutic plasma exchange has been tried as a treatment approach for
systemic sclerosis since 1978 based on the rationale that some circulating
factor is involved in disease pathogenesis, for example, autoantibodies or
immune complexes, and that removing the potential pathogenic factors could
lead to symptom improvement. Based on our impression that clinicians and
researchers are largely unaware that a large volume of research has been
published about the use of therapeutic plasma exchange as a treatment for
systemic sclerosis, we conducted a comprehensive review and analysis of all
published research on this topic.
Results:
We identified 46 relevant articles that met our search criteria, involving a
total of 572 patients. Of these, 19 were case studies; the rest ranged from
small observational studies to prospective randomized clinical trials. In
all but two studies, most patients receiving therapeutic plasma exchange
showed improvements in both clinical symptoms and laboratory markers,
including significant improvement in Raynaud’s symptoms and healing of
digital ulceration after three to four weekly treatments. The beneficial
effects from even a short course of therapeutic plasma exchange treatments
were long-lasting, typically 6 months or longer. Therapeutic plasma exchange
was very well tolerated. Adverse events were rare and, in almost all cases,
mild and transitory.
Conclusion:
These results suggest that long-term therapeutic plasma exchange may offer a
low-risk way to control and in some cases reverse systemic sclerosis
symptoms. The mechanism for the clinical improvements seen from therapeutic
plasma exchange in systemic sclerosis patients is unclear. Therefore,
additional studies of therapeutic plasma exchange effects in systemic
sclerosis appear to be highly desirable.
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