Selective Immune Adsorption Treatment of Severe Guillain Barré Syndrome in the Intensive Care Unit

Galldiks, Norbert; Dohmen, Christian; Neveling, M.; Fink, Gereon R.; Haupt, Walter F.

doi:10.1007/s12028-009-9252-6

Cited by 24 publications

(19 citation statements)

References 16 publications

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“…Additional experience showed that increasing the number of apheresis sessions did not correlate with further improvement of outcome (data not shown). This observation is in accord with results of IA in acute autoimmune neuropathies like Guillain-Barré Syndrome [20]. …”

Section: Discussionsupporting

confidence: 91%

Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis

Koziolek

Tampe

Bahr

et al. 2012

J Neuroinflammation

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BackgroundIn multiple sclerosis relapses refractory to intravenous corticosteroid therapy, plasma exchange is recommended. Immunoadsorption (IA) is regarded as an alternative therapy, but its efficacy and putative mechanism of action still needs to be established.MethodsWe prospectively treated 11 patients with multiple sclerosis who had optical neuritis and fulfilled the indications for apheresis therapy (Trial registration DE/CA25/00007080-00). In total, five IA treatments were performed using tryptophan-IA. Clinical activity (visual acuity, Expanded Disability Status Scale, Incapacity Status Scale), laboratory values and visual evoked potentials were measured before, during and after IA, with a follow-up of six months. Moreover, proteomic analyses were performed to analyze column-bound proteins as well as corresponding changes in patients’ sera.ResultsAfter the third IA, we detected an improvement of vision in eight of eleven patients, whom we termed responders. Amongst these, the mean visual acuity improved from 0.15 ± 0.12 at baseline to 0.47 ± 0.32 after the third IA (P = 0.0252) up to 0.89 ± 0.15 (P < 0.0001) at day 180 ± 10 after IA. Soluble interleukin-2 receptor decreased in responders (P = 0.03), whereas in non-responders it did not. Proteomic analyses of proteins adsorbed to IA columns revealed that several significant immunological proteins as well as central nervous system protein fragments, including myelin basic protein, had been removed by IA.ConclusionsIA was effective in the treatment of corticosteroid-refractory optic neuritis. IA influenced the humoral immune response. Strikingly, however, we found strong evidence that demyelination products and immunological mediators were also cleared from plasma by IA.

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Section: Discussionsupporting

confidence: 91%

Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis

Koziolek

Tampe

Bahr

et al. 2012

J Neuroinflammation

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“…Like in other autoimmune neurological diseases [25,41,42] rapid recovery from life threatening crisis or acute relapses could be achieved with three to six treatments within a period of 1 to 2 weeks.…”

mentioning

confidence: 99%

A randomized and controlled study comparing immunoadsorption and plasma exchange in myasthenic crisis

Köhler

Bucka

Klingel

2011

J of Clinical Apheresis

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Myasthenic crisis is the most serious life-threatening event in Myasthenia gravis patients, affecting up to 27% within the first two years after onset of disease. Extracorporeal removal of circulating autoantibodies against the nicotinic acetylcholine receptor (AChRAb) by methods of therapeutic apheresis, e.g. plasma exchange (PE) and immunoadsorption (IA) had been demonstrated as effective treatment especially in acute situations of myasthenic crisis. However, controlled data comparing clinical safety and efficacy of both methods in a clinical study were not available. Here the results of a prospective randomized controlled clinical trial are presented, investigating 19 patients with myasthenic crisis, who were randomized to receive either PE (n = 10) or IA (n = 9) in addition to combined drug treatment. Patients received 3 to 5 (mean 3.5 for PE, and 3.4 for IA) treatments over a period of 7 days with a predefined treatment volume of 1.5 l plasma (i.e., 20-25 ml/kg plasma representing 0.5-0.6 patients' plasma volumes). Clinical courses were monitored using disease specific clinical scores. After initiation of IA or PE the mean value of Myasthenia scores decreased equally until Day 14 of the post-treatment phase. Patients from both treatment groups improved to a stable clinical status of Oosterhuis Classes 1 and 2. Substantial reduction of AChRAb was documented after each session of PE or IA. In the treatment period 16 adverse effects (seven serious adverse events, SAE) in the PE and 10 (1 SAE) in the IA group were observed. In conclusion, IA proved to be equally effective compared with PE treatment in patients with myasthenic crisis. Three to five treatment sessions using low plasma volume dosage of 20-25 ml/kg were adequate to improve clinically relevant symptoms significantly in most patients.

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“…In addition to regulatory approval, issues of reimbursement might prevent recent use of IA. In Germany, selective IA has been increasingly used in autoimmune-related neurological diseases due to its equivalent efficacy and advantageous safety profile [23]. It had been shown that IA is an effective treatment for GBS patients [23,24,25].…”

Section: Discussionmentioning

confidence: 99%

“…In Germany, selective IA has been increasingly used in autoimmune-related neurological diseases due to its equivalent efficacy and advantageous safety profile [23]. It had been shown that IA is an effective treatment for GBS patients [23,24,25]. However, although IA therapy has been used as a treatment option for CIDP for a number of years, the efficacy of IA treatment for CIDP had not been analyzed in a larger number of patients yet, and only few case reports are found in the literature [38,39,40].…”

Section: Discussionmentioning

confidence: 99%

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Immunoadsorption in Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy with Unsatisfactory Response to First-Line Treatment

Galldiks¹,

Burghaus²,

Dohmen³

et al. 2011

Eur Neurol

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Background/Aims: First-line treatment options for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are corticosteroids, intravenous immunoglobulin, and plasma exchange. In a significant number of patients, first-line therapy fails, and long-term maintenance treatment still remains a therapeutic challenge. Immunoadsorption (IA) may be an alternative to classical plasma exchange in the therapy of immune-mediated neurologic diseases. The aim of this investigation was to evaluate efficacy and safety of IA in patients with CIDP with unsatisfactory response to first-line treatment options. Methods: CIDP patients received adjunct IA treatment using tryptophan-immune adsorbers. The inflammatory neuropathy cause and treatment disability (INCAT) score was used to grade disability and monitor treatment effects. Results: In total, 14 CIDP patients were analyzed. Ten patients were treated in hospital. After one IA treatment series, the INCAT score decreased significantly in all 10 patients. Four of these 14 patients were treated in outpatient clinics using long-term maintenance IA with 1–2 treatments per week. In these 4 patients, effects of long-term maintenance IA resulted in an improvement of overall disability. In all patients, IA was safe, well tolerated, and no severe adverse effects occurred. Conclusion: IA could be an effective and safe option for CIDP patients with unsatisfactory response to first-line treatment options and for long-term maintenance treatment.

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Selective Immune Adsorption Treatment of Severe Guillain Barré Syndrome in the Intensive Care Unit

Abstract: In severely affected GBS patients admitted to ICU treatment with SIA seems to be safe and effective. In comparison to treatment with SIA only, sequential therapy with IVIG was not more effective.

Cited by 24 publications

References 16 publications

Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis

Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis

A randomized and controlled study comparing immunoadsorption and plasma exchange in myasthenic crisis

Immunoadsorption in Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy with Unsatisfactory Response to First-Line Treatment

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