Plasma Exchange Therapy to Reduce Mortality in Japanese Patients With Diffuse Alveolar Hemorrhage and Microscopic Polyangiitis

Clinical application of blood purification in polymyositis/dermatomyositis

INTRODUCTION

We investigated the clinical efficacy and safety of blood purification technology in patients with polymyositis/dermatomyositis.

METHODS

In a study of 22 patients, 10 cases received blood purification treatment (5 cases received plasma exchange, 5 cases received plasma HA280 immunoadsorption), and 12 cases served as the control group. A 3-month follow-up was conducted to compare the clinical manifestations and laboratory examination.

RESULTS

Symptoms and signs of patients in treatment group were significantly improved, and the hormone usage was lower than the control group. For patients with normal creatine kinase level and ferritin level below three times the upper limit of normal, there was a positive correlation between their N/L values and MDAAT scores.

CONCLUSION

The results of this study suggest that blood purification therapy, including plasma HA280 immunoadsorption and plasma exchange, is an effective and safe treatment for patients with polymyositis/dermatomyositis, offering assistance in reducing hormone usage in the long-term.

Efficacy of plasma exchange therapy for diffuse alveolar hemorrhage in patients with microscopic polyangiitis

INTRODUCTION

Diffuse alveolar hemorrhage (DAH) is associated with high mortality. We examined the efficacy of plasma exchange (PE) therapy for reducing mortality in patients with patients with microscopic polyangiitis (MPA) and DAH.

METHODS

In this 52-week, non-randomized, open-label, one-arm, historical control, double-center controlled trial, four patients with MPA and DAH admitted to Juntendo University Hospital or Juntendo Koto Geriatric Medical Center between 2018 and 2021 were enrolled. Sixteen patients with MPA and DAH admitted to the two centers between 1998 and 2018 who did not receive PE were included as the historical control group. The primary outcome was the 52-weekurvival rate of patients in each treatment arm.

RESULTS

The 52-week survival rate of patients in the PE group (n=4) was higher than that of the historical control group (n=16) (100% vs. 13%, P=.04).

CONCLUSION

We found that PE may be efficacious for reducing mortality in patients with MPA and DAH. This article is protected by copyright. All rights reserved.

Management of Myositis-Associated Interstitial Lung Disease

Idiopathic inflammatory myopathies, including polymyositis (PM), dermatomyositis (DM), and clinically amyopathic DM (CADM), are a diverse group of autoimmune diseases characterized by muscular involvement and extramuscular manifestations. Interstitial lung disease (ILD) has major pulmonary involvement and is associated with increased mortality in PM/DM/CADM. The management of PM-/DM-/CADM-associated ILD (PM/DM/CADM-ILD) requires careful evaluation of the disease severity and clinical subtype, including the ILD forms (acute/subacute or chronic), because of the substantial heterogeneity of their clinical courses. Recent studies have highlighted the importance of myositis-specific autoantibodies’ status, especially anti-melanoma differentiation-associated gene 5 (MDA5) and anti-aminoacyl tRNA synthetase (ARS) antibodies, in order to evaluate the clinical phenotypes and treatment of choice for PM/DM/CADM-ILD. Because the presence of the anti-MDA5 antibody is a strong predictor of a worse prognosis, combination treatment with glucocorticoids (GCs) and calcineurin inhibitors (CNIs; tacrolimus (TAC) or cyclosporin A (CsA)) is recommended for patients with anti-MDA5 antibody-positive DM/CADM-ILD. Rapidly progressive DM/CADM-ILD with the anti-MDA5 antibody is the most intractable condition, which requires immediate combined immunosuppressive therapy with GCs, CNIs, and intravenous cyclophosphamide. Additional salvage therapies (rituximab, tofacitinib, and plasma exchange) should be considered for patients with refractory ILD. Patients with anti-ARS antibody-positive ILD respond better to GC treatment, but with frequent recurrence; thus, GCs plus immunosuppressants (TAC, CsA, azathioprine, and mycophenolate mofetil) are often needed in order to achieve favorable long-term disease control. PM/DM/CADM-ILD management is still a therapeutic challenge for clinicians, as evidence-based guidelines do not exist to help with management decisions. A few prospective clinical trials have been recently reported regarding the treatment of PM/DM/CADM-ILD. Here, the current knowledge on the pharmacologic managements of PM/DM/CADM-ILD was mainly reviewed.