Immunotherapy and other novel therapies, including biologic response modifiers, apheresis, and dietary modifications

Immunologic manipulations under current investigation include various biologic agents and pheresis procedures. Second-generation monoclonal antibodies have been "humanized" to circumvent human anti-mouse antibody production or to carry toxin amplification. At present these studies focus on refractory rheumatoid arthritis and lupus nephritis. Interferons, prostacyclin, and tolerance-inducing or blocking peptides are filling difficult therapeutic niches. Of particular importance are remarkable results for interferon alfa-2b in mastocytosis, and iloprost in Raynaud's disease with digital ulcerations. Enhanced pheresis procedures with photochemotherapy involving psoralens and extracorporeal removal of specific autoantibodies may broaden the spectrum of pheresis applications. Dietary manipulations of fatty-acid intake and caloric restriction have also received attention.