TREATMENT OF AUTOIMMUNE-DISEASE BY IMMUNOMODULATION THROUGH EXTRACORPOREAL ELIMINATION AND INTRAVENOUS IMMUNOGLOBULIN

If customary drug mediated immunosuppressive therapy leads to intolera ble side effects or is inefficient, extra-corporeal elimination and un targeted or targeted immunoglobin therapy modulating the immune respon se are taken into consideration for the treatment of patients with aut oimmune diseases. Both elimination and immunoglobulin therapy, are not alternatives but appear to act complementary, if sequentially applied . Selective immunoadsorption is increasingly applied for extracorporea l elimination and is able to replace plasma exchange therapy. Both, hy drophobic interaction chromatography and affinity chromatography are e ffective in given clinical conditions. Therapeutic affinity chromatogr aphy appears to be superior to hydrophobic interaction chromatography, if an effective, rapid elimination of the disease promoting agent is desired. Experience with therapeutic chromatography collected in the p ast, indicates that a rapid elimination of immunoglobulins and the sub sequent intravenous infusion of 7S immunoglobulin is superior to elimi nation or untargeted immunomodulation alone. These experimental approa ches lead to an extension of the available treatment modalities. Howev er, controlled trials rather than anecdotal reports are needed, to pro vide substantial information.