A systematic review of the efficacy of direct hemoperfusion with a polymyxin B–immobilized fibre column to treat rapidly progressive interstitial pneumonia

Abstract

Objectives: Rapidly progressive interstitial pneumonia is a fatal disease with no established therapeutic options. The aim of this systematic review is to clarify the efficacy of interstitial pneumonia treatment utilizing direct hemoperfusion with a polymyxin B–immobilized fibre column. Methods: All patients with adult-onset rapidly progressive interstitial pneumonia including acute exacerbation of underlying chronic interstitial pneumonia were eligible. Primary studies of any design, which compared outcomes of direct hemoperfusion with a polymyxin B–immobilized fibre column treatment such as oxygenation and all-cause mortality with those of conventional therapy, were included. Electronic databases such as Medline and EMBASE were searched through October 7, 2018, and ICHUSHI, the largest database for medical articles in Japan, was also searched. Two reviewers independently extracted the relevant data and assessed the risk of bias in individual studies. The results were reported qualitatively due to substantial heterogeneity between studies. Results: Out of 775 records retrieved, 10 reports were eligible and 8 of them were included for further analysis. They were all retrospective studies including a total of 327 patients and contained some risk of bias. There was variation in the administration method of direct hemoperfusion with a polymyxin B–immobilized fibre column treatment such as the timing, frequency, duration and interval. Multivariate analyses of only two studies with historical controls demonstrated beneficial effects of direct hemoperfusion with a polymyxin B–immobilized fibre column treatment over conventional therapy with all-cause mortality hazard ratios of 0.345 (95% confidence interval: 0.127–0.936) and 0.505 (95% confidence interval: 0.270–0.904), respectively. A significant difference of an improvement in the ratio of partial arterial oxygen pressure to the fraction of inspired oxygen in-between two treatment groups was also reported in two studies utilizing historical controls with mean differences of 56.8 and 57.5 mmHg, respectively. Conclusions: There is currently insufficient data to support the use of direct hemoperfusion with a polymyxin B–immobilized fibre column treatment for rapidly progressive interstitial pneumonia. It should be instituted for research purposes only until new evidence is available.

The efficacy of recombinant human soluble thrombomodulin (rhsTM) treatment for acute exacerbation of idiopathic pulmonary fibrosis: a systematic review and meta-analysis

“…Two reviewers (HK and OMP) independently screened retrieved records by titles and abstracts as well as fulltexts if needed to select eligible reports. The same reviewers extracted relevant data similarly referring to a previous review of a similar subject [27]. These data included the first author's name and publication year, study location, number of subjects and their demographic features in each treatment group, prior therapy and conjunctive treatment for AE, outcomes, number of subjects who developed the outcome, summary statistics and adverse events related to rhsTM treatment.…”

Therapeutic plasma exchange for clinically amyopathic dermatomyositis (CADM) associated with rapidly progressive interstitial pneumonia

“…[26][27][28] However, data are currently insufficient to support the use of PMX-DHP for RPIP, according to a recent systematic review. 29 In addition, the fact that the incidence of cartridge clotting of PMX-DHP is not low represents a major problem. 30 DNA IA is a procedure in which plasma from the patient is separated from the blood, then passed through a medical device with the capacity to remove immunoglobulins by specifically binding them to the active component of the device.…”