Effects of Direct Hemoperfusion with Polymyxin B-immobilized Fiber on Rapidly Progressive Interstitial Lung Diseases

Abstract

Objective Direct hemoperfusion with polymyxin B-immobilized fiber columns (PMX-DHP) has been used for the treatment of septic shock. It was recently suggested that PMX-DHP may also be effective in acute exacerbations of idiopathic pulmonary fibrosis (IPF). However, all previous reports are case series without controls. The aim of the study was to determine the effects of PMX-DHP on the prognosis of the patients with rapidly progressive interstitial lung diseases (ILDs) in a case-control setting. Methods We herein retrospectively examined the clinical records of consecutive patients with acute exacerbation of IPF or rapidly progressive ILDs treated in our institute. We excluded those who had been treated with steroid pulse therapy for lung diseases, including those who had been taking more than 15 mg of oral prednisolone daily, or had undergone an operation within one month before the onset of acute respiratory failure. We compared the results of the laboratory tests and survivals between patients treated with and without PMX-DHP. Results Twenty-six patients were enrolled in the study. Among them, 13 patients were treated with PMX-DHP in addition to immunosuppressive therapy, including steroid pulse therapy. The mean survival time of patients treated with PMX-DHP tended to be longer than patients not treated with PXM-DHP (p=0.067). Six patients who underwent PMX-DHP on the first day of steroid pulse therapy had significantly longer survival times than those who were treated with standard medication alone (p<0.01). Conclusion These results suggest that PMX-DHP performed on the first day of steroid pulse therapy may improve the prognosis of patients with rapidly progressive ILDs.

Direct hemoperfusion with polymyxin B‐immobilized fibre treatment for acute exacerbation of interstitial pneumonia

“…While we found no significant difference in the overall survival proportion between our ILD patients with and without PMX‐DHP treatment, the patients treated with PMX‐DHP within 3 days of AE onset showed better prognosis. This result was compatible with a previous report demonstrating a better prognosis in patients undergoing PMX‐DHP on the first day with steroid pulse therapy compared with patients treated with immunosuppressant alone …”

“…PMX‐DHP was originally invented as a method to remove endotoxins and improve the haemodynamics and P/F ratio in patients with septic shock by adsorbing the circulating endotoxins in blood via direct extracorporeal hemoperfusion without exerting toxicity . Recent studies have suggested that PMX‐DHP may improve the prognosis of patients with AE‐IPF or dermatomyositis . Most of these studies report that PMX‐DHP improves oxygenation and decreases white blood cell counts.…”

Acute exacerbation of idiopathic pulmonary fibrosis: shifting the paradigm

“…Both approaches are typically followed by a rapid taper and cessation of prednisone within several weeks, based on the rationale that chronic prednisone use is likely harmful in IPF [9]. Several other investigational agents have been studied in AE-IPF including polymyxin B-immobilised fibre cartridge [61][62][63][64], tacrolimus [65] and cyclosporine [66][67][68]; however, there are currently insufficient data to support the routine use of these medications.…”

Polymyxin B‐immobilized fiber column direct hemoperfusion and continuous hemodiafiltration in premature neonates with systemic inflammatory response syndrome

“…Decreased levels of not only endotoxin, but also various mediators including IL‐6, IL‐8, IL‐10, tumor necrosis factor‐α, and interferon‐γ are reported in patients treated with PMX‐DHP . PMX‐DHP was first developed in Japan in the early 1990s with the aim of removing circulating endotoxin, and is becoming established for the treatment of adult sepsis and is suggested to improve oxygenation in patients with various lung diseases . In this study, 2 h CHDF was added to the latter half of 4 h PMX‐DHP in the active treatment group.…”