Performance, clinical effectiveness, and safety of immunoadsorption in a wide range of indications

Abstract

Immunoadsorption is well known to selectively remove immunoglobulins and immune complexes from plasma and is applied in a variety of autoimmune diseases and for desensitization before, or at acute rejection after organ transplantation. Performance, safety, and clinical effectiveness of immunoadsorption were the aim of this study. This prospective, noninterventional, multicentre cohort study included patients treated with immunoadsorption (Immunosorba or GLOBAFFIN adsorbers) for any indication. Clinical effectiveness was assessed after termination of the patient's individual treatment schedule. Eighty‐one patients were included, 69 were treated with Immunosorba, 11 with GLOBAFFIN, one patient with both adsorbers. A majority of patients was treated for neurological indications, dilated cardiomyopathy, and before or after kidney or heart transplantation. Mean IgG reduction from pre‐ to post‐treatment was 69.9% ± 11.5% for Immunosorba and 74.1% ± 5.0% for GLOBAFFIN, respectively. The overall IgG reduction over a complete treatment block was 68%–93% with Immunosorba and 62%–90% with GLOBAFFIN depending on the duration of the overall treatment. After termination of the immunoadsorption therapy, an improvement of clinical status was observed in 63.0%, stabilization of symptoms in 29.6%, and a deterioration in 4.9% of patients. Changes in fibrinogen, thrombocytes, and albumin were mostly classified as noncritical. Overall, the treatments were well tolerated. Immunoadsorption in routine clinical practice with both GLOBAFFIN and Immunosorba has been safely performed, was well tolerated by patients, and effective in lowering immunoglobulins with an improvement or maintenance of clinical status, thus represents an additional therapeutic option for therapy refractory immune disorders.

SARS-CoV-2 IgG spike protein antibody response in mRNA-1273 Moderna® vaccinated patients on maintenance immunoapheresis – a cohort study

“…Second, we demonstrated that IgG apheresis decreased the SARS-CoV-2 IgG S antibody levels by about 64% per treatment session. This is comparable with the total IgG reduction per treatment and according to results reported by others ( 19 ). However, due to the lower detection limits of our laboratory we could not exactly calculate total IgG decrease.…”

The effect of double filtration plasmapheresis and corticosteroids on patients with anti‐dipeptidyl‐peptidase‐like protein 6 encephalitis

“…As revealed by symptom remission and improved mRS scores, the patients responded well to treatment and their symptoms improved. What's more, immunoadsorption (IA) is a potential method of apheresis that selectively removes immunoglobulins while preserving other plasma proteins [14]. It may be considered as a treatment option for anti-DPPX encephalitis since the anti-DPPX antibodies are predominantly comprised of IgG1 and IgG4 [8], however, further research is necessary to determine its efficacy.…”

“…Currently, there are no specialized therapies for anti-DPPX encephalitis, but immunotherapy is commonly used and has potential benefits for most patients [2,12]. The efficacy of plasma exchange, a first-line therapy for anti-NMDA receptor encephalitis, remains unclear for patients with anti-DPPX encephalitist [13,14]. Further investigations are needed to better understand this disease and develop effective treatments.…”

Novel insights in the clinical management of hyperimmune patients before and after transplantation

“…To date, immunotherapy with chimeric anti-CD20 monoclonal antibody (Rituximab) has demonstrated some efficacy by offering a potentially safe and effective treatment ( Green et al, 2019 ). The same is true for removal of antibodies through regular plasmapheresis, immunoadsorption ( Fuchs et al, 2022 ) or possibly proteasome inhibition ( Alishetti et al, 2020 ) that could be methods to reduce the risk of allograft failure.…”