Tryptophan‐immobilized Column‐based Immunoadsorption as the Choice Method for Plasmapheresis in Guillain–Barré Syndrome

Abstract

Plasmapheresis is widely performed as treatment for patients with Guillain-Barré syndrome (GBS) in the acute phase. As tryptophan-immobilized column-based immunoadsorption (Tr-IA) is a safer method than either double-filtration plasmapheresis (DFPP) or plasma exchange (PE), we investigated whether or not Tr-IA is as effective as other methods, and should be selected as the procedure of choice in patients with GBS. We retrospectively compared clinical outcomes, using Hughes grading, in GBS patients treated with Tr-IA, DFPP or PE. The outcome in the Tr-IA group was also compared historically with patients treated by PE in seven previous studies. We studied 34 patients with GBS: 20 were treated with Tr-IA, 11 with DFPP, and 3 with PE. The age, sex, duration from onset to initiation of treatment, and Hughes grade at entry did not differ among the Tr-IA, DFPP and PE groups. There was no significant difference in outcomes among these three groups, nor was there a significant difference between the outcomes in the Tr-IA and DFPP groups with respect to subgroups of Hughes grade at entry. Also, our Tr-IA group did not show a different outcome from the previously reported patients treated with PE. The frequency of complications in our Tr-IA group is significantly lower than that in both our DFPP group, and in the previously reported cases of patients treated with PE. Tr-IA, DFPP and PE have almost the same efficacy in patients with GBS, but Tr-IA is recommended as the plasmapheresis method of choice because of its safety.

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

“…SIA has been used as an alternative to PE in Japan, Germany, and other countries, and has been shown to provide a positive effect in the treatment of GBS patients with SIA being at least as efficacious as but safer than PE [6][7][8].…”

“…In previous studies with less severely affected GBS patients, the treatment option SIA was recommended among the currently available methods of plasmapheresis for the treatment of GBS because of its safety [8,9]. To date, however, investigations of patients with GBS treated with SIA were performed only in a small number of patients.…”

Guillain-Barre syndrome

“…Однако результаты сравнительного анализа эффективности иммуносорбции, двойного филь-трационного ПФ и обычного ПФ у больных СГБ не продемонстрировали значимого преимущес-тва данных методов над ПФ [11,22,27].…”

Plasmaaustausch als Therapieoption bei neurologischen Erkrankungen

“…Auch hier wurden keine signifikanten Unterschiede hinsichtlich der primären und sekundären Zielgrö-ßen festgestellt. Hinsichtlich der Wirksamkeit und Sicherheit der Immunadsorptionsverfahren konnten in kleinen, retrospektiven Studien keine signifikanten Unterschiede zum Plasmaaustausch festgestellt werden [28,29]. Die selektive Entfernung vermutlich pathogener Antikörper durch spezifisch ausgelegte Immunaffinitätssäulen könnte jedoch einen Weg darstellen, das therapeutische Verfahren in Zukunft zu optimieren und Nebenwirkungen auf ein Minimum zu reduzieren [94].…”

“…Nach der Adsorption werden die zellulären Blutbestandteile und das Plasma wieder zusammengeführt und reinfundiert. Dieses Verfahren ist bereits zur Behandlung verschiedener neurologischer Erkrankungen eingesetzt worden, beispielsweise bei MS [10], MG [11] und GBS[28,29].Tab. 1 Ausgewählte Studien zum Einsatz des Plasmaaustauschs beim Guillain-Barré-Syndrom…”