State of the Evidence: Drug Removal via Apheresis

Binns, Thomas C; Sostin, Nataliya; Tormey, Christopher A.

doi:10.1016/j.tmrv.2022.12.003

Cited by 5 publications

(2 citation statements)

References 38 publications

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“…These factors include: (1) antibody distribution volume, of which approximately 45% of IgG is intravascular; (2) the equilibration rate between physiologic compartments, which for immunoglobulins occurs at approximately 1 to 3% per hour; and (3) increasingly inefficient intraprocedural IgG removal, as an exchange of 1 plasma volume will only remove approximately 63% of intravascular IgG. [24][25][26] With these kinetics in mind, the first few TPE procedures would likely remove a significant proportion of an anti-GBM IgG antibody. However, after these initial procedures, the value of daily procedures becomes more dependent upon factors such as IgG anabolism as total stores from presentation are depleted.…”

Section: Discussionmentioning

confidence: 99%

“…This is because the efficacy of immunoglobulin removal via TPE depends on multiple factors. These factors include: (1) antibody distribution volume, of which approximately 45% of IgG is intravascular; (2) the equilibration rate between physiologic compartments, which for immunoglobulins occurs at approximately 1 to 3% per hour; and (3) increasingly inefficient intraprocedural IgG removal, as an exchange of 1 plasma volume will only remove approximately 63% of intravascular IgG 24‐26 . With these kinetics in mind, the first few TPE procedures would likely remove a significant proportion of an anti‐GBM IgG antibody.…”

Section: Discussionmentioning

confidence: 99%

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Immunity in the balance: Fatal disseminated adenovirus infection in a patient undergoing plasma exchange and immunosuppressive chemotherapy for anti‐glomerular basement membrane disease

Jacobs,

Villalba,

Stendahl

et al. 2023

J of Clinical Apheresis

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Anti‐glomerular basement membrane (anti‐GBM) disease (formerly known as Goodpasture's syndrome) is a rare autoinflammatory condition that affects the renal and/or pulmonary capillaries. The standard therapeutic regimen for anti‐GBM disease involves therapeutic plasma exchange (TPE), cyclophosphamide, and corticosteroids to rapidly remove and inhibit autoantibody production and reduce organ inflammation. Herein we report an 82‐year‐old female who developed anti‐GBM disease but expired despite therapy, secondary to multi‐organ failure in the setting of disseminated adenovirus disease. We discuss the utility and potential adverse effect of daily TPE for a protracted course (ie, 10‐14 days), the recommended TPE intensity in the 2023 American Society for Apheresis guidelines, updated from every‐other‐day TPE in the 2019 guidelines, despite no new data. We also highlight the potential for unusual infections to occur in these patients due to the profound immunosuppression, and discuss the importance of balancing immunosuppression to treat the disease with close surveillance of any potential opportunistic infections.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Immunity in the balance: Fatal disseminated adenovirus infection in a patient undergoing plasma exchange and immunosuppressive chemotherapy for anti‐glomerular basement membrane disease

Jacobs,

Villalba,

Stendahl

et al. 2023

J of Clinical Apheresis

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Minimal impact of low-density lipoprotein apheresis on vancomycin serum concentration: A case report

Hiyama,

Tomita,

Matsuo

2024

Journal of Infection and Chemotherapy

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Examination of drug removal profiles in patients undergoing therapeutic plasma exchange: A retrospective study

Balaban,

Kara,

Mahmoud

et al. 2024

Ther Apher Dial

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IntroductionTherapeutic plasma exchange (TPE) eliminates disease‐contributing substances but may also affect drug concentrations. This study aimed to assess the prevalence of prescription drugs removable via TPE by reviewing patient medication histories.MethodsA retrospective, single‐center study was conducted from January 1, 2021 to December 31, 2022. The study included 244 patients undergoing 1087 TPE sessions. Drugs prescribed to patients on TPE days were categorized as “yes” (probably removable), “maybe” (possibly removable), and “no” (unlikely removable) regarding their removability via TPE.ResultsAmong 3966 prescriptions, 556 (14.0%) were analyzed, with 21.8%, 36.5%, and 41.7% falling into the “yes,” “maybe,” and “no” categories for removability. Although only 14.0% were categorized, 83.6% of patients received at least one analyzable drug. Among them, 83.8% had at least one potentially removable drug.ConclusionReal‐world data highlights the need for caution in drug treatments during TPE to ensure optimal therapeutic outcomes, particularly for specific drugs.

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State of the Evidence: Drug Removal via Apheresis

Cited by 5 publications

References 38 publications

Immunity in the balance: Fatal disseminated adenovirus infection in a patient undergoing plasma exchange and immunosuppressive chemotherapy for anti‐glomerular basement membrane disease

Immunity in the balance: Fatal disseminated adenovirus infection in a patient undergoing plasma exchange and immunosuppressive chemotherapy for anti‐glomerular basement membrane disease

Minimal impact of low-density lipoprotein apheresis on vancomycin serum concentration: A case report

Examination of drug removal profiles in patients undergoing therapeutic plasma exchange: A retrospective study

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