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Adjunctive plasma exchanges to treat neuropsychiatric lupus: a retrospective study on 10 patients

Department of Internal Medicine, Hôpital Cochin, Assistance Publique — Hôpitaux de Paris, Université Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France, Department of Internal Medicine, Hôpital Henri-Mondor, Assistance Publique — Hôpitaux de Paris, Université Paris 12, 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil Cedex, France

S. Bréchignac

Unité de Médecine Transfusionnelle, Hôpital Avicenne, Assistance Publique — Hôpitaux de Paris, Université Paris 13 Nord, 125 route de Stalingrad, 93000 Bobigny, France

P. Cohen

Department of Internal Medicine, Hôpital Cochin, Assistance Publique — Hôpitaux de Paris, Université Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France

V. Le Guern

Department of Internal Medicine, Hôpital Cochin, Assistance Publique — Hôpitaux de Paris, Université Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France

L. Guillevin

Department of Internal Medicine, Hôpital Cochin, Assistance Publique — Hôpitaux de Paris, Université Descartes Paris 5, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France, loic.guillevin{at}cch.aphp.fr

Neuropsychiatric manifestations of systemic lupus erythematosus (NPSLE) are among the main causes of morbidity and mortality attributed to lupus activity. Conventional NPSLE treatment combines CS and immunosuppressants, but some symptoms do not respond. We retrospectively evaluated the adjunction of plasma exchanges (PE) to treat 13 NPSLE flares occurring in 10 patients (mean age, 30 years) between 1989 and 2002. NP manifestations were the first SLE symptoms for seven patients, with a mean of 3.2 NP manifestations/flare. All patients received CS and cyclophosphamide pulses. A mean of 15 PE/flare were performed. All patients improved within a mean of 3 (median: 2.5; range: 1.5—8) weeks thereafter. Complete remissions of 7/13 flares were obtained within a mean of 7 (median: 4; range: 2—22) weeks. Partial remissions were achieved for the remaining six flares, characterized by new NP manifestations during three and insufficient control of the others. Other SLE manifestations regressed for all patients with the mean European consensus lupus activity measurement score declining from pretreatment 6.9 to 1.2. A regimen combining CS, cyclophosphamide and PE is effective against severe NPSLE, with acceptable toxicity. Lupus (2007) 16, 817—822.

Key Words: central nervous system involvement • cyclophosphamide • plasma exchange • systemic lupus erythematosus • therapy

Lupus, Vol. 16, No. 10, 817-822 (2007)
DOI: 10.1177/0961203307081840


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