Plasmapheresis/immunoadsorption in patients with pemphigus

Abstract

Background and Design: Plasmapheresis and immunoadsorption, which is a more advanced method, are among the treatment options that induce a rapid remission in severe and resistant pemphigus. The aim of this study was to evaluate the efficacy and safety of plasmapheresis and immunoadsorption therapies via the clinical experience gained from our patients with pemphigus vulgaris (PV) and paraneoplastic pemphigus (PNP). Materials and Methods: Among patients who were diagnosed with pemphigus according to the histopathology and/or immunofluorescence methods and followed-up at our bullous diseases outpatient clinic between the years 1987 and 2013, 7 patients (5 PV, 2 PNP), who were treated with plasmapheresis or immunoadsorption, were retrospectively analyzed. Among these patients, 3 were treated with classical plasmapheresis, whereas 2 with double-filtration plasmapheresis, 1 with immunoadsorption, and 1 initially with classical plasmapheresis followed by immunoadsorption due to impairment of the hemodynamic parameters. The clinical findings, antibody titers, and immunological responses before and after the therapy, the therapy dosages and adverse effects were evaluated according to the data gained from the patient files. Results: In 4 patients (1., 3., 4. and 5. patients) with pemphigus vulgaris, complete clinical response was achieved, while 1 patient (2. patient) showed partial regression in skin lesions. In two patients (6., 7. patients) with paraneoplastic pemphigus, the therapy discontinued due to complications. In all of the evaluated patients, the analysis of the antibody titers before and after the therapy revealed lower levels in