From the Guidelines
Eosinophilic Granulomatosis with Polyangiitis (EGPA) without organ-threatening or life-threatening manifestations is not an indication for Therapeutic Plasma Exchange (Plasmapheresis).
Indications for Plasmapheresis
- The provided evidence suggests that plasmapheresis is recommended for patients with ANCA-associated vasculitis with severe kidney impairment or active vasculitis despite ongoing remission induction therapy 1.
- It is also recommended for patients with rapidly progressive severe renal disease to improve renal survival 1.
- Additionally, plasmapheresis is suggested for patients with an overlap syndrome of ANCA vasculitis and anti-GBM 1.
Non-Indications for Plasmapheresis
- However, for patients with EGPA without organ-threatening or life-threatening manifestations, treatment with glucocorticoids is recommended, and plasmapheresis is not indicated 1.
- Furthermore, in patients with AAV and pulmonary haemorrhage without kidney involvement, immunosuppression alone without plasma exchange is suggested 1.
Key Considerations
- The decision to use plasmapheresis should be based on the individual patient's risk of developing end-stage kidney disease (ESKD) and the potential benefits and harms of the treatment 1.
- The evidence suggests that plasmapheresis may be beneficial for patients with moderate-high or high risk of developing ESKD or requiring dialysis, but the harms may outweigh the benefits for patients with low or low-moderate risk 1.
From the Research
Conditions Not Indicated for Therapeutic Plasma Exchange
- Rheumatoid arthritis, as stated in 2, where controlled clinical trials found no therapeutic benefit of plasma exchange.
- Systemic lupus erythematosus, as mentioned in 2, where plasma exchange therapy was not found to be beneficial by controlled clinical trials.
- Polymyositis, as indicated in 2, where therapeutic benefit of plasma exchange was not found by controlled clinical trials.
- Dermatomyositis, as stated in 2, where controlled clinical trials found no therapeutic benefit of plasma exchange.
- Multiple sclerosis, as mentioned in 2, where plasma exchange therapy was not found to be beneficial by controlled clinical trials.
- Rejection of kidney allotransplant, as indicated in 2, where therapeutic benefit of plasma exchange was not found by controlled clinical trials.
Conditions with Limited or No Benefit from Therapeutic Plasma Exchange
- ANCA-related vasculitis, as discussed in 3 and 4, where recent randomized controlled trials have shown mixed or negative results for the use of plasma exchange.
- ANCA-associated vasculitis (AAV), as mentioned in 5, where the PEXIVAS trial did not show a clear benefit of adjunctive plasma exchange on a combined end point of end-stage kidney disease and death. However, plasma exchange may still be considered in certain groups of patients, such as those with severe renal involvement or life-threatening pulmonary hemorrhage.