Sallee Marion, Resseguier Noémie, Crepin Thomas, Bertin Daniel, Bertrand Dominique, Bobot Mickaël, Krummel Thierry, Maillard Nicolas, Moussi-Frances Julie, Pelletier Marion, Poullin Pascale, Rafat Cédric, Robert Thomas, Terrier Benjamin, Rostaing Lionel, Faguer Stanislas, Jourde-Chiche Noémie
AP-HM, Hôpital de la Conception, Centre de Néphrologie et Transplantation Rénale, Marseille, France.
Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France.
Kidney Int Rep. 2024 Jun 27;9(9):2767-2773. doi: 10.1016/j.ekir.2024.06.031. eCollection 2024 Sep.
Apheresis allows the fast removal of autoantibodies in anti-glomerular basement membrane (anti-GBM) disease, and in severe antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. The CINEVAS study tested whether immunoadsorption (IA) allowed a faster removal of ANCA and/or anti-GBM antibodies than plasma exchanges (PEx).
CINEVAS was a prospective multicenter study comparing IA to PEx in consecutive patients with ANCA and/or anti-GBM vasculitides. The primary objective was the reduction rate in autoantibody titers between the beginning of the first and the end of the seventh apheresis session. Secondary objectives were number of sessions needed to obtain desired reduction rates; reduction rates of total Ig levels; tolerance of sessions; and patients' outcome.
The results of 38 patients (16 treated with IA and 22 with PEx), and 43 autoantibodies, were analyzed. There was no difference in the reduction rates in autoantibody titers between IA and PEx over 7 sessions (respectively 98% vs. 96%, = 0.39). The numbers of sessions needed to obtain undetectable autoantibodies, or 50%, 75%, or 90% reductions, did not differ between techniques. Greater reduction rates of autoantibodies were observed when plasma was separated by filtration compared to centrifugation, with IA and PEx. IA allowed a greater reduction in total IgG levels, and better preservation of total IgA and IgM levels than PEx. PEx sessions required higher volumes of plasma, IA sessions higher volumes of citrate; IA sessions were longer.
IA and PEx were comparable in ANCA or anti-GBM removal kinetics, despite a faster reduction in total IgG with IA.
单采术可快速清除抗肾小球基底膜（anti-GBM）病以及重症抗中性粒细胞胞浆抗体（ANCA）相关性血管炎中的自身抗体。CINEVAS研究旨在测试免疫吸附（IA）是否比血浆置换（PEx）能更快清除ANCA和/或抗GBM抗体。
CINEVAS是一项前瞻性多中心研究，比较IA与PEx对连续的ANCA和/或抗GBM血管炎患者的治疗效果。主要目标是第一次单采术开始至第七次单采术结束期间自身抗体滴度的降低率。次要目标包括达到期望降低率所需的单采术次数；总免疫球蛋白水平的降低率；单采术的耐受性；以及患者的预后。
分析了38例患者（16例接受IA治疗，22例接受PEx治疗）及43种自身抗体的结果。在7次单采术中，IA和PEx之间自身抗体滴度的降低率无差异（分别为98%对96%，P = 0.39）。两种技术在使自身抗体不可检测或降低50%、75%或90%所需的单采术次数上没有差异。与离心法分离血浆相比，采用过滤法分离血浆时，IA和PEx均观察到自身抗体有更大的降低率。与PEx相比，IA能使总IgG水平有更大程度的降低，同时能更好地保留总IgA和IgM水平。PEx单采术需要更高体积的血浆，IA单采术需要更高体积的枸橼酸盐；IA单采术时间更长。
尽管IA能更快降低总IgG水平，但在清除ANCA或抗GBM的动力学方面，IA和PEx具有可比性。
