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Published on: July 23, 2016
Plasma exchange in endocrine ophthalmopathy
1Department of Internal Medicine, University Hospital, Linköping, Sweden.
Journal of Clinical Apheresis
|January 1, 1990
Summary
Plasma exchange offers potential relief for severe endocrine ophthalmopathy by reducing immune complexes. Early intervention before fibrotic changes is crucial for better outcomes in Graves
Area of Science:
- Endocrinology
- Immunology
- Ophthalmology
Background:
- Endocrine ophthalmopathy (EO) is a serious complication of Graves' disease and Hashimoto's thyroiditis.
- Current treatments for EO have limitations, necessitating exploration of novel therapeutic approaches.
- Intensive plasma exchange (PLEX) is an extracorporeal procedure that removes plasma components, including antibodies and immune complexes.
Purpose of the Study:
- To evaluate the efficacy of intensive plasma exchange in patients with active endocrine ophthalmopathy.
- To assess the impact of PLEX on clinical parameters such as proptosis, ophthalmopathy index, and periorbital edema.
- To investigate the changes in circulating immune complexes and thyrotropin receptor antibodies (TRAbs) following PLEX.
Main Methods:
- A cohort of 13 patients (12 with Graves' disease, 1 with Hashimoto's thyroiditis) with EO underwent intensive PLEX.
- Each patient received six PLEX sessions over 2-3 weeks, exchanging an average of 2.4 liters of plasma per session.
- Concomitant treatment with azathioprine was administered to most patients.
Main Results:
- A prompt reduction in circulating immune complexes and/or TRAbs was observed post-PLEX.
- Six out of 13 patients showed improvement in proptosis, particularly those with symptom duration less than 8 months.
- Nine patients experienced improvement in their ophthalmopathy index and periorbital edema.
Conclusions:
- Intensive plasma exchange can provide symptomatic relief in patients with disabling endocrine ophthalmopathy, especially when initiated early before fibrotic changes occur.
- Concomitant immunosuppressive therapy is recommended to prevent potential rebound effects after PLEX.
- Further controlled studies are warranted to definitively establish the role of PLEX in EO management.
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