Controlled trial of plasma exchange and leukapheresis in polymyositis and dermatomyositis

Frederick W. Miller, Susan F. Leitman, Mary E. Cronin, Jeanne E. Hicks, Richard L. Leff, Robert Wesley, David D. Fraser, Marinos Dalakas, Paul H. Plotz

Research output: Contribution to journalArticlepeer-review

Abstract

Background. The therapeutic options for patients with polymyositis or dermatomyositis that is resistant to corticosteroids are limited, unproved, and often toxic. Uncontrolled trials concluded that both plasma exchange and leukapheresis are beneficial, but despite the considerable use of these approaches, proof of their efficacy is lacking. Methods. Thirty-nine patients with definite polymyositis or dermatomyositis were randomly assigned to receive plasma exchange (replacement of one volume of plasma with 5 percent albumin in saline), leukapheresis (removal of 5 × 109 to 10 × 109 lymphocytes), or sham apheresis in a double-blind manner, with 12 treatments given over a one-month period. Muscle strength, functional capacity, and serum levels of muscle-associated enzymes were measured before and after the 12 procedures. Results. In each group 3 of 13 patients had improvements in strength and functional capacity. The condition of 3 patients treated with leukapheresis and 1 treated with plasma exchange deteriorated, and it was unchanged in the other 26 patients. Adverse effects of apheresis included the need for a central venous catheter (9 patients), major vasovagal episodes (3 patients), and severe citrate reactions (2 patients). Despite the occurrence of significant reductions in the serum levels of muscle enzymes with plasma exchange (P

Original languageEnglish (US)
Pages (from-to)1380-1384
Number of pages5
JournalNew England Journal of Medicine
Volume326
Issue number21
StatePublished - May 21 1992
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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