Evidence for a Therapeutic Effect of Plasmapheresis in Patients with Systemic Lupus Erythematosus

Fourteen patients with active systemic lupus erythematosus (SLE)have been treated with plasmapheresis at a rate of two litresdaily on three to four days per week, over a period of two tothree weeks. Plasma was replaced isovolemically with eitherfresh frozen plasma or with human plasma protein fractions.Ten patients were receiving treatment with prednisone at thetime of plasmapheresis, and four had received no prior treatment.Eight patients showed evidence of either clinical improvementor clinical and immunochemical improvement, at the time of plasmapheresis.In the three patients who showed high levels of circulatingcomplexes before treatment, there was a sudden fail in the levelof circulating immune complexes, which was quantitatively greaterthan could be explained by the amount removed. This suggeststhat in some patients with SLE, clearance of complexes by themononuclear phagocytic system is initially blocked by high levelsof circulating complexes and that one effect of plasmapheresismay be to relieve this blockade. Five patients showed a clinicalresponse to plasmapheresis despite the fact that tests for immunecomplexes were negative. Three patients showed no response toplasmapheresis, and three were regarded as unevaluable. In a limited number of patients, who show a high level of circulatingimmune complexes, and whose condition is deteriorating despitetreatment with corticosteroids, there may he an important therapeuticrole for plasmapheresis.