Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Plasma exchange (PE) is usually used to treat severe primary systemic necrotizing vasculitides (SNVs) and/or virus-induced vasculitides. Only severe renal insufficiency (serum creatinine (SCR) >500 µmol/l) was validated but long-term outcomes remain poor. In practice, PE may be used in clinical situations without literature input. This study aimed to identify practical PE indications for nonviral SNVs and evaluate short-term and long-term prognoses.
This multicenter retrospective study (2005–2014) included PE-treated patients with AAV or nonviral polyarteritis nodosa (PAN) meeting ACR criteria, EMA algorithm and/or Chapel Hill nomenclature. For each indication, analysis of short- and long-term outcomes compared baseline (M0) vs post-PE parameter values.
Diagnoses of the 152 patients [94 men, 58 women; median age 64 (range 17–89) yr] were: 87 granulomatosis with polyangiitis (GPA), 56 microscopic polyangiitis (MPA), 5 PAN and 4 eosinophilic granulomatosis with polyangiitis (EGPA). ANCA were positive in 142/147 (97%, never PAN): 55% PR3-ANCA+ and 45% MPO-ANCA+.
PE was used for rapidly progressive glomerulonephritis (RPGN) in 126 (83%) [mean SCR 465±257 µmol/l; including <250, 250–500 and >500 µmol/l in one-third each], 64 (42%) alveolar hemorrhage most often RPGN-associated, 23 (15%) with extensive and severe multiple mononeuropathy, usually of acute onset (<4 weeks) and severe motor weakness, and 7 (5%) with extensive skin necrosis. M0 median BVAS was 18. Median (range) PE was 7 (1–12) sessions over a median of 11 (1–43) days.
After median follow-up of 22 (range 1–125) months post-PE onset, 18 (12%) had died, including 11 within M1–6. Renal function of 126 PE-treated RPGN patients improved significantly, as assessed by estimated glomerular filtration rate (eGFR) using MDRD, reaching a plateau between M3 and M6 post-PE onset, and maintaining eGFR through follow-up M24. According to M0-SCR (µmol/l) subgroup, M0-to-M6 eGFR (ml/min), respectively, rose from 33.3 to 47.3 (P<0.0001) for <250, from 13.5 to 34.7 (P<0.0001) for 250–500, and from 6.9 to 32.9 (P<0.0001) for >500. PE-session numbers were similar for the 3 M0-SCR subgroups, with eGFR improving as that number rose, suggesting a PE dose-dependent effect on eGFR recovery.
PE resolved alveolar hemorrhages in all 64 patients, enabling O2-therapy or MV discontinuation, after a median of 15 days.
Motor weakness regressed markedly in 23 PE-treated extensive mononeuritis patients. Severe motor-weakness (MRC <3/5) declined from M0 52% to 23%, 19% and 12.5% at M3, M6 and M12 post-PE onset.
End-stage renal disease and/or mortality rates were similar among M0-SCR groups but higher for MPO- than PR3-ANCA+ patients. PE-attributable adverse events occurred in 63%. No one died during PE.
Our results highlight PE indications for SNVs. Different organ involvements seem to benefit from PE. For RPGN patients, the PE number seemed to correspond to the degree of eGFR recovery. These findings support using PE in conditions less severe than previously validated.
To cite this abstract in AMA style:De Luna G, Chauveau D, Aniort J, Carron PL, Gobert P, Karras A, Adam-Marchand S, Maurier F, Hatron PY, Mania A, Le Guenno G, Ballly S, Bienvenu B, Cardineau E, Goulenok T, Jourde-Chiche N Sr., Samson M, Huart A, Pourrat J, Tiple A, Aumaître O, Puéchal X, Heshmati F, Le Jeunne C, Mouthon L, Guillevin L, Terrier B. Plasma Exchanges to Treat Primary Systemic Necrotizing Vasculitides: Data from a French Nationwide Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/plasma-exchanges-to-treat-primary-systemic-necrotizing-vasculitides-data-from-a-french-nationwide-study/. Accessed September 19, 2021.
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