CYCLOSPORINE AND THERAPEUTIC PLASMA-EXCHANGE IN TREATMENT OF PROGRESSIVE AUTOIMMUNE-DISEASES

Despite treatment with intensive immunosuppressive drug regimens, the prognosis of patients suffering from severe progressive autoimmune dis eases like systemic lupus erythematosus (SLE), nephrotic syndrome (NS) , and Behcet's disease is poor. Side effects (infections and malignant tumors) often occur. In the present trial, 35 patients suffering from autoimmune diseases (SLE, n = 21; NS, n = 10; and Behcet's disease, n = 4) were treated for 3.7 +/- 2.0 years with 2.5 +/- 0.6 mg cyclospor ine/kg body weight/day in addition to corticosteroids alone or in comb ination with azathioprine and/or cyclophosphamide. In active stages of the diseases with extremely high concentrations of anti-ds-DNA-antibo dies, antinuclear antibodies, circulating immunocomplexes, and reduced complement concentrations, therapeutic plasma exchange (TPE) has been applied. Compared with previous treatment modalities, significantly ( p < 0.05) more effective and rapid reductions of the antibodies were r eached. Clinical disorders improved within 1-6 weeks. All patients rep orted increased performance and a better quality of life. After 1-12 m onths, the previously required doses of immunosuppressive drugs and th e frequency of TPE could be reduced by 40-100%. After 13.4 +/- 11.8 mo nths in 17 of 35 patients (8 with SLE, 5 with NS, 4 with Behcet's dise ase), cyclosporine was established as the monotherapy. No severe side effects were registered. In treating active stages of severe progressi ve autoimmune diseases and forms with persistent high antibody levels, the addition of TPE to conventional therapy was very effective, as ob served in both clinical and laboratory parameters.