A 15-year report of indications, adverse events, and effectiveness of therapeutic plasma exchange in patients with rheumatic diseases

Therapeutic plasma exchange (TPE) is a type of treatment, which eliminates harmful antibodies, immune complexes, cytokines, and inflammatory products. Due to the lack of sufficient data on indications, effectiveness, and side effects of TPE in patients with rheumatic disease, we evaluated TPE in our center. All consecutive patients registered in university hospitals with definite rheumatologic indications for TPE during 15 years were evaluated. 680 sessions of TPE were performed on 166 patients, aged between 19 and 83 years. The most common underlying causes were collagen vascular diseases (60%) including systemic lupus erythematosus (SLE) (98%), and antiphospholipid antibody syndrome (APS) (1%); and then, primary small vessel vasculitis (SVV) (39.8%). The main indications for TPE in all patients were rapidly progressive glomerulonephritis (RPGN) (69.8%) and pulmonary hemorrhage (39.1%). During 12 months follow-up, in SLE and SVV patients 17 (17.3%) and 20 (30.3%) entered complete remission; 37 (37.3%) and 12 (18.1%) entered partial remission; 44 (44.8%) and 34 (51.5%) had no recovery; and 37(37%) and 19 (28.7%) died, respectively. A total of 18 (10.8%) patients experienced TPE-related adverse events during TPE [hypotension 15 (9%), allergic reaction 1 (0.6%), fever 1 (0.6%), and hypocalcemia 1 (0.6%)]. The most common indication for TPE is SLE and primary vasculitis. The RPGN and pulmonary hemorrhage were the main indications. Although the rate of response to treatment was acceptable according to the fatal nature of these complications, further case-control studies are suggested to assess the effectiveness of TPE.