Document 0173
 DOCN  M9460173
 TI    [Immunoglobulins or plasma exchange? Synchronization of plasma exchange
       and intravenous polyvalent immunoglobulins. A consecutive study of 11
       patients]
 DT    9408
 AU    Bussel A; Boulechfar H; Naim R; Unite d'Hemapherese Therapeutique,
       Secteur; d'Hemobiologie-Transfusion de Paris-Est, Hopital Saint-Louis.
 SO    Ann Med Interne (Paris). 1993;144(8):532-8. Unique Identifier : AIDSLINE
       MED/94234622
 AB    Synchronization is defined as a prescription sequence aimed at obtaining
       synergic response or potentialization. THEORETICAL BASIS--The concept of
       synchronization is based on clinical and biological observations such as
       similar indications and transient effectiveness. Certain mechanisms of
       action such as reduction of pathological autoantibodies and accelerated
       elimination of immune complexes are common to both methods. Inversely,
       long-term effects differ. Plasma exchange cannot control the synthesis
       (or could aggravate) of autoantibodies while gammaglobulins have a
       suppressor effect on autoreactive clones. The aim is to obtain a
       summation effect by eliminating immediately cytotoxic factors. The
       potentializing effect of gammaglobulin anti-idiotypes on the
       modification of the immunologic repertory is favoured by prior reduction
       in the level of circulating pathogenic antibodies. RESULTS--It is
       difficult to evaluate the efficacy of this therapeutic association. Only
       a few trials have been conducted in refractory autoimmune thrombopenic
       purpura (n = 8), in intra-uterine Rhesus disease (n = 3), and HIV
       associated pathologies. We report our experience in 11 patients in a
       situation of therapeutic failure including three cases of renal
       transplantation, two cases each of chronic polyradiculoneuritis and
       neurological paraneoplastic syndromes, and one case each of Wegener's
       syndrome, polymyositis, sclerokeratitis, and antiphospholipid antibodies
       during pregnancy. Immunoglobulins were injected at an initial dose of 2
       g/kg following at least 3 plasma exchanges. Consolidation cures were
       then administered every 3 weeks at a dose of 1 g/kg. Two major
       complications occurred and required interruption of the treatment: acute
       regressive oligo-anuric renal failure (Wegener) and exacerbation of
       sclerokeratitis inflammatory lesions. The disease process was controlled
       in 7 patients. CONCLUSIONS--Despite these promising preliminary results,
       the proposed combination therapy is not devoid of complications and its
       cost is high (cost of PE for 500 mg/kg Ig is about 5,000 FF). The next
       step should be the study of experimental models and prospective trials
       on pathologies with well characterized immunological features.
 DE    Adult  Aged  Antibodies/ANALYSIS  Autoantibodies/ANALYSIS  Autoimmune
       Diseases/THERAPY  Combined Modality Therapy  English Abstract  Female
       Human  Immunoglobulins, Intravenous/*THERAPEUTIC USE  Immunologic
       Diseases/*THERAPY  Male  Middle Age  *Plasma Exchange  Pregnancy
       Pregnancy Complications/IMMUNOLOGY/THERAPY  Retrospective Studies  Time
       Factors  JOURNAL ARTICLE

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