Division of Nephrology, University of Virginia, Charlottesville, Virginia, USA.
Department of Medicine, Division of Nephrology, University of California, and Therapeutic Apheresis Program, UCSD Medical Center, San Diego, California, USA.
J Clin Apher. 2020 Sep;35(5):493-499. doi: 10.1002/jca.21820. Epub 2020 Aug 7.
Since 1986, the American Society for Apheresis (ASFA) has published practice guidelines on the use of therapeutic apheresis in the Journal of Clinical Apheresis (JCA) Special Issue. Since 2007, updated guidelines have been published every 3 years to reflect current evidence based apheresis practice with the most recent edition (8th) published in 2019. With each edition, the guidelines are reviewed and updated based on any newly published literature since the last review. The PEXIVAS study, an international, randomized controlled trial comparing therapeutic plasma exchange (TPE) vs no TPE and standard vs reduced dose steroid regimen on the primary composite outcome of end stage renal disease or death in patients with ANCA-associated vasculitis (AAV), was published in February 2020. This study represents the largest study on the role of therapeutic apheresis in AAV published to date and prompted the JCA Special Issue Writing Committee to reassess the current AAV fact sheet for updates based on this newly available evidence. This interim fact sheet summarizes current ASFA recommendations for the evidence-based use of therapeutic apheresis in AAV and supersedes the recommendations published in the 2019 guidelines.
自 1986 年以来，美国体外治疗协会（ASFA）一直在《临床体外治疗杂志》（JCA）特刊上发表关于治疗性体外疗法应用的实践指南。自 2007 年以来，每 3 年更新一次指南，以反映基于当前证据的最新体外治疗实践，最近一版（第 8 版）于 2019 年发布。每次更新，都根据上次审查以来新发表的文献对指南进行审查和更新。PEXIVAS 研究是一项国际性、随机对照试验，比较了在抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）患者中，治疗性血浆置换（TPE）与无 TPE 以及标准与降低剂量类固醇治疗方案对终末期肾病或死亡的主要复合结局的影响，该研究于 2020 年 2 月发表。这项研究是迄今为止发表的关于治疗性体外疗法在 AAV 中作用的最大研究，促使 JCA 特刊写作委员会根据这一新的可用证据重新评估当前 AAV 情况说明书以进行更新。本临时情况说明书总结了当前 ASFA 在 AAV 中基于证据的治疗性体外疗法应用的建议，取代了 2019 年指南中发布的建议。
