Peptide GAM immunoadsorption in anti‐PLA₂R positive autoimmune membranous nephropathy. The PRISM trial

Citations Over TimeTop 20% of 2021 papers

Abstract

Membranous nephropathy associated with anti-PLA₂ R autoantibody is a significant cause of nephrotic syndrome worldwide. Treatment remains empiric with a significant side-effect burden despite an increase in our understanding of the disease. We studied the effect of selectively removing this pathogenic autoantibody using immunoadsorption in adult patients with biopsy proven anti-PLA₂ R membranous nephropathy. This was a multicenter, single-arm prospective clinical trial carried out in the United Kingdom. Twelve patients underwent five consecutive sessions of peptide GAM immunoadsorption with 12 months follow-up. Primary outcome was anti-PLA₂ R titer at week 2. Secondary outcomes were safety and tolerability of therapy, antibody profile, and change in proteinuria, renal excretory function, serum albumin, total immunoglobulin, and quality of life at weeks 12, 24, and 52. Patients were also stratified by the presence or absence of the high-risk allele (heterozygous or homozygous for HLA-DQA1*05). Median pretreatment anti-PLA₂ R was 702.50 U/mL, 1045.00 U/mL at week 2 (P-value .023) and 165.00 U/mL at week 52 (P-value .017). The treatment was well tolerated and safe. Two patients required rescue immunosuppression during the follow-up period. There was a significant improvement in serum albumin with a median at baseline of 20.50 g/L rising to 25.00 g/L at week 52 (P-value 2 R titers, possibly representing a cohort more likely to benefit from immunoadsorption. Immunoadsorption therapy is a safe treatment and well-tolerated treatment in anti-PLA₂ R positive autoimmune membranous nephropathy.

Related Papers

• → Extracorporeal Immunoadsorption for the Treatment of Haemophilia Patients with Inhibitors to Factor VIII or IX(1999)9 cited
• → Extracorporeal Immunoadsorption for the Treatment of Haemophilic Patients with Inhibitors to Factor VIII or IX(1999)37 cited
• → Immunoadsorption(2018)1 cited
• The clinical study of staphylococcal protein A immunoadsorption in the treatment of generalized myasthenia gravis(2007)
• Therapeutic Efficacy and Nuring Experience in the Treatment of SLE by Immunoadsorption(2012)