Panimmunoglobulin and IgE-selective extracorporeal immunoadsorption in patients with severe atopic dermatitis

Reich, Kristian; Deinzer, Julia; Fiege, Anne-Kathrin; Gruben, V. von; Sack, Anna-Lena; Thraen, Alice; Weisenseel, Peter; Breuer, Kristine; Jäckle, Stefan; Meier, Markus

doi:10.1016/j.jaci.2016.01.016

Cited by 25 publications

(48 citation statements)

References 17 publications

(14 reference statements)

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“…[12][13][14]16,17,20 Such protocols applied reusable adsorbers that are designed for 10-20 treatments. [12][13][14]16,17,20 Such protocols applied reusable adsorbers that are designed for 10-20 treatments.…”

Section: Discussionmentioning

confidence: 99%

“…This favorable outcome-also with regard to IA-imminent infectious events 13,21 -may be attributed to the IgE selectivity of the tested column. 13 One major limitation of this pilot study is the absence of a placebo control. 13 Other common AEs considered to be related to (nonselective, that is, pan-Ig IA) IA itself in the background of AD (eg, herpes labialis or herpes keratitis caused by HSV-1; bacterial conjunctivitis caused by Staphylococcus aureus; and bacterial sinusitis) were not observed in our study cohort.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies and case series have already shown efficacy of pan-Ig and IgE-selective IA in AD with comparable efficacy. [12][13][14]16,17,20 Such protocols applied reusable adsorbers that are designed for 10-20 treatments. To meet functional needs due to limited durability and storability of these adsorbers, study plans applying reusable devices are commonly adjusted to include 4 to 5 days of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Their distinct role in the complex pathogenesis of AD, however, remains unknown. While different protocols have been used applying IA either with pan-Ig (four studies, 53 patients) [12][13][14][15] or IgE-selective adsorbers (three studies, 38 patients) 13,16,17 as well as in combination with omalizumab (one study, 10 patients), all these regimes were reported to induce a significant improvement of disease severity in the majority of patients (and partly irrespective of IgE load) for at least 3-6 months beyond therapy. Thus, omalizumab failed to improve AD symptoms or revealed nonsuperiority to placebo in several clinical trials.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11] Immunoadsorption (IA), aiming at an immunomodulatory depletion of pathogenic serum mediators, was previously reported to cause disease amelioration paralleled by normalization of cutaneous inflammatory parameters (ie, density of CD3 + , CD4 + , CD1a + cellular infiltrates) in AD patients refractory to multiple conventional treatment strategies including cyclosporine A. While different protocols have been used applying IA either with pan-Ig (four studies, 53 patients) [12][13][14][15] or IgE-selective adsorbers (three studies, 38 patients) 13,16,17 as well as in combination with omalizumab (one study, 10 patients), all these regimes were reported to induce a significant improvement of disease severity in the majority of patients (and partly irrespective of IgE load) for at least 3-6 months beyond therapy.…”

Section: Introductionmentioning

confidence: 99%

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Single‐use IgE‐selective immunoadsorber column for the treatment of severe atopic dermatitis

Meyersburg

Laimer

Kügler

et al. 2019

J of Clinical Apheresis

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Background: Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease with unmet therapeutic need in a critical cohort of recalcitrant cases. Immunoadsorption (IA) aims at an immunomodulatory depletion of pathogenic serum mediators and has recently revealed promising clinical results for the treatment of AD.Objective: To determine efficacy, sustainability, safety, and clinical impact of IgE selective IA in AD using a single-use IgE immunoadsorber column.Methods: This open-label pilot study comprised five patients (mean SCORAD 67.9 ± 11.4, range 52.2-81.9; mean serum IgE level 5904 ± 5945 U/mL, range 1000-15 600 IU/mL) who underwent IgE-selective IA. Three patients continued prior therapy with systemic immunosuppressive drugs during IA as an add-on therapeutic approach. All patients received three courses of IA. The first course consisted of three consecutive daily treatments followed by two sequences with two consecutive applications. All courses were performed on a monthly regimen.Results: IA proved efficacy in selectively depleting serum IgE levels in all participants (mean reduction by cycle of 81% ± 12%, range 64%-93%). It further led to a clinically relevant and sustained improvement of AD with a maximum decline in SCORAD and EASI scores by up to 35% and 52%, respectively, compared to baseline. Scores persisted below baseline for at least 12 weeks beyond the last IA. The intervention was also well tolerated with no severe adverse events during a total of 35 procedures.Conclusion: Data of this preliminary trial indicates clinical efficacy, feasibility, safety as well as tolerability of IgE-selective IA in AD. K E Y W O R D S atopic dermatitis, IgEnio, immunoadsorption # Damian Meyersburg and Martin Laimer contributed equally to this work.

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