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Relapsing and Progressive Complications of Severe Hypertriglyceridemia: Effective Long-Term Treatment with Double
Clemens Grupp1,2, Johannes Beckermann3, Eric Köster4
1Department of Nephrology, Academic Teaching Hospital Bamberg, Bamberg, Germany.
Insights
Double filtration plasmapheresis (DFPP) effectively prevents recurrent pancreatitis and cardiovascular events in severe hypertriglyceridemia (HTG) patients. This safe treatment stabilizes patients refractory to standard therapies, reducing complications significantly.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Technology
Background:
- Severe hypertriglyceridemia (HTG) poses significant risks, including acute pancreatitis (AP) and atherosclerotic cardiovascular disease (ASCVD).
- Double filtration plasmapheresis (DFPP) shows promise for acute HTG management, but long-term efficacy data are limited.
Purpose of the Study:
- To assess the efficacy and safety of regular DFPP in preventing recurrent HTG-associated complications.
- To evaluate DFPP in patients with severe HTG refractory to conventional treatments.
Main Methods:
- A retrospective multicenter study involving patients with severe, drug- and diet-refractory HTG undergoing regular DFPP.
- Comparison of complication rates before and during DFPP treatment.
Main Results:
- Ten patients with severe HTG (median TG 5,487 mg/dL) were observed for a mean of 3.9 years pre-DFPP and 3.8 years post-DFPP.
- The annual rate of HTG-associated complications decreased from 1.4 to 0 (p < 0.005), a 77% reduction.
- DFPP was safe, well-tolerated, and effective in eliminating triglyceride-rich lipoproteins, with 60% of patients experiencing no AP or ASCVD progression.
Conclusions:
- Regular, long-term DFPP stabilizes patients with severe HTG and associated complications who are resistant to standard therapies.
- DFPP offers a safe and effective therapeutic option for managing refractory hypertriglyceridemia and preventing severe adverse events.
Background:
Severe hypertriglyceridemia (HTG) is associated with major complications such as acute or relapsing pancreatitis (AP) and atherosclerotic cardiovascular disease (ASCVD). Rapid elimination of triglyceride (TG)-rich lipoproteins (LP) with double filtration plasmapheresis (DFPP) without need for substitution has been found to be effective for the acute, short-term treatment of HTG-induced AP. Data on the long-term use of DFPP to prevent HTG-associated complications are scarce.
Objectives:
To evaluate the use and efficacy of regular DFPP treatment in clinical practice for preventing recurrence of HTG-associated complications in thera-py refractory patients.
Methods:
Retrospective multicenter study in patients with severe symptomatic drug and diet refractory HTG with regular DFPP treatment. Patients' incidence of HTG-associated pancreatic or cardiovascular complications was compared before treatment and with regular DFPP treatment.
Results:
Ten patients (3 female) were identified with baseline maximal TG concentrations of 2,587-28,090 mg/dL (median 5,487 mg/dL; interquartile range [IQR] 4,340-12,636). The mean observation period was 3.9 ± 3.4 years before and 3.8 ± 3.0 years after commencement of DFPP. In 5 patients, severe HTG was related to chylomicronemia, 2 patients had familial partial lipodystrophy Dunnigan, and 1 patient had additional LP(a)-hyperlipoproteinemia. The main HTG-associated complication was recurrent AP in 8 patients, including 1 patient treated during pregnancy. Two patients presented severe progressive ASCVD. With long-term DFPP treatment, the annual rate of HTG-associa-ted pancreatic or cardiovascular complications declined from median 1.4 (IQR 0.7-2.6) to 0 (IQR 0.0-0.4; p < 0.005). The absolute number of events was reduced by 77%. In 6 patients (60%) episodes of AP did not occur, nor was progression of ASCVD detected clinically or by routine imaging techniques. DFPP was effective in the elimination of TG-rich LP from plasma, and was safe and well-tolerated.
Conclusion:
Long-term, regular DFPP treatment resulted in stabilization of patients with severe HTG and related recurrent AP or progression of ASCVD, who were refractory to conventional dietary and drug therapy.
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