Immunoadsorption in systemic lupus erythematosus: different techniques and their current role in medical therapy

In the last 30 years, several studies have documented the effect of plamapheresis and immunoadsorption in eliminating pathogenic autoantibodies (AB) and immune complexes (IC) from circulation of patients with systemic lupus erythematosus (SLE). However, these extracorporeal therapies are still not accepted as first line options, which may be because of existing controlled studies failing to confirm any obvious benefit. Immunoadsorption offers some advantages compared with plasmapheresis, but until today only the avoidance of any substitution fluids has really been used. The new therapeutic options given by immunoadsorbers--a continuous application in acute disease states or chronic use instead of immunosuppressive drugs--have still to be evaluated in systemic autoimmune diseases. To date published studies of immunoadsorption in patients with SLE reveal good efficacy in a majority of patients combined with excellent biocompatibility. Randomized controlled trials are mandatory to give continued support to the therapeutic opportunities offered only by immunoadsorption; the limited number of patients suitable for this therapy necessitates multicentric cooperation.