CYCLOSPORINE AND PLASMAPHERESIS IN TREATMENT OF PROGRESSIVE SYSTEMIC LUPUS-ERYTHEMATOSUS (PSLE)

The prognosis of patients suffering from progressive systemic lupus er ythematosus (pSLE) is poor, despite treatment with intensive drug regi mens with combinations of corticosteroids, azathioprine and cyclophosp ahmide. Side-effects such as infections and malignomas often occur. In the present trial, 21 patients (four male, 17 female, aged 37.9 +/- 1 2.8), suffering from pSLE for 9.4 +/- 2.6 years, were treated for 2.3 +/- 1.8 years with drug regimens as mentioned above. Then, over a peri od of 6.4 +/- 2.6 (range 1-8) years, in addition to conventional thera pies, cyclosporin (2.5 +/- 0.6 mg/kg body wt/d) and, in active stages of the disease with extremely high concentrations of anti-ds-DNA-, ant i-nuclear antibodies and circulating immunocomplexes, plasmapheresis ( therapeutic plasma exchange (TPE)) have been applied. Compared with pr evious treatment modalities, significantly (P < 0.05) more effective a nd rapid reduction of antibodies was achieved. Clinical symptoms impro ved within 2 to 4 weeks. Under the new therapeutic regimen all patient s reported increased performance and a better quality of life. After 5 to 48 (17.5 +/- 13.8) months, cyclosporin was established as mono-the rapy for 8/21 patients. In] the other cases, corticosteroids, azathiop rine and cyclophosphamide were reduced by 40 to 100%. No severe side-e ffects were seen. In acute stages of pSLE and in forms with persistent ly high antibody levels, the addition of TPE to conventional therapy w as very effective, with regard to improving both clinical and laborato ry parameters. (C) 1997 Elsevier Science Ltd.