Therapeutic Membrane Plasmapheresis
Is Plasmapheresis a Maintenance or a Curative Therapy?
Since plasmapheresis is so closely related to dialysis, it’s fair to ask whether plasmapheresis is a maintenance therapy (like dialysis) or a curative therapy. In fact, the answer depends on the disease being treated. Here, we will examine two closely related diseases: Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Guillain-Barré Syndrome, also known as Acute Inflammatory Demyelinating Polyneuropathy.
These two diseases are identical, with the exception that the first is chronic (long-lasting or recurrent) while the other is its acute counterpart (short duration and rapidly progressive). The similarity of the two diseases provides an interesting perspective on the usage of plasmapheresis as both a maintenance therapy and as a curative therapy.
Chronic Inflammatory Demyelinating Polyradiculoneuropathy:
Plasmapheresis is considered a Category I treatment for this disease, meaning that therapeutic plasmapheresis is a standard first-line therapy and efficacy of the treatment has been proven in clinical trials and published experience. Plasmapheresis leads to short-term improvement but if treatment is discontinued, rapid deterioration usually follows. This is presumably because the autoimmune response is continuous, so the initial removal of self-targeting antibodies from the body is soon followed by further production of the same antibodies. In many patients, this continuous renewal of self-targeting antibodies necessitates the implementation of maintenance plasmapheresis as a therapy.
An antibody
The frequency of this maintenance therapy may range from weekly to monthly depending on how soon after each treatment the patient begins to experience symptoms.
Guillain-Barré Syndrome (Acute Inflammatory Demyelinating Polyneuropathy):
Plasmapheresis is also considered a Category I treatment for this disease (see above for explanation of Category I). When used for treatment within two weeks of the onset of the disease, plasmapheresis is very effective therapy, and significant improvements are usually seen. In general, five to six treatments performed every other day are sufficient for most patients. Guillain-Barré syndrome is an example of a disease for which plasmapheresis being utilized as a curative therapy, as further treatments are usually unnecessary. This is likely because the production of self-targeting antibodies is temporally limited, and the body does not produce more antibodies once they are removed through plasmapheresis.
Conclusion:
Plasmapheresis is used as both a maintenance and a curative therapy. Broadly speaking, plasmapheresis is usually employed as a curative therapy rather than a maintenance therapy, simply because most of the diseases for which plasmapheresis is an effective treatment are not chronic diseases. However, a significant number of diseases exist that may require maintenance plasmapheresis (see also familial hypercholesterolemia).
Sources:
French Cooperative Group. Efficiency of Plasma Exchange in Guillain-Barré Syndrome: Role of Replacement Fluids. Annals of Neurology 1987, Vol 22 No 6.Szczepiorkowski Z et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Apheresis Applications Committee of the American Society for Apheresis. Journal of Clinical Apheresis 2007; 22.
Bio 1080 (Organ Replacement) - Spring 2008
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