Abstract：
BACKGROUND: Therapeutic apheresis (TA) is commonly used for cryoglobulinemic vasculitis (CV) patients, but its efficacy remains uncertain. This systematic review aimed to assess the efficacy of different TA modalities, such as plasma exchange (PE), plasmapheresis (PP), and cryofiltration (CF), in treating CV patients with renal involvement.
METHODS: Literature search of MEDLINE, EMBASE, and Cochrane Databases was conducted up to December 2022. Studies that reported the outcomes of TA in adult CV patients with renal involvement were assessed. The protocol for this systematic review has been registered with PROSPERO (No. CRD42023417727). The quality of each study was evaluated by the investigators using the validated methodological index for non-randomized studies (minors) quality score.
RESULTS: 154 patients who encountered 170 episodes of serious events necessitating TA were evaluated across 76 studies. Among them, 51% were males, with a mean age ranging from 49 to 58 years. The CV types included 15 type I, 97 type II, and 13 type III, while the remaining patients exhibited mixed (n = 17) or undetermined CV types (n = 12). Among the treatment modalities, PE, PP, and CF were performed in 85 (56%), 52 (34%), and 17 patients (11%), respectively, with no identical protocol for TA treatment. The overall response rate for TA was 78%, with response rates of 84%, 77%, and 75% observed in type I, II, and III patients respectively. Most patients received steroids, immunosuppressants, and treatment targeting the underlying causative disease. The overall long-term renal outcome rate was 77%, with type I, II, and III patients experiencing response rates of 89%, 76%, and 90%, respectively. The renal outcomes in patients receiving PE, PP, and CF were comparable, with rates of 78%, 76%, and 81%, respectively.
CONCLUSIONS: This study presents compelling evidence that combination of TA with other treatments, especially immunosuppressive therapy, is a successful strategy for effectively managing severe renal involvement in CV patients. Among the TA modalities studied, including PE, PP, and CF, all demonstrated efficacy, with PE being the most frequently employed approach.
METHODS: Literature search of MEDLINE, EMBASE, and Cochrane Databases was conducted up to December 2022. Studies that reported the outcomes of TA in adult CV patients with renal involvement were assessed. The protocol for this systematic review has been registered with PROSPERO (No. CRD42023417727). The quality of each study was evaluated by the investigators using the validated methodological index for non-randomized studies (minors) quality score.
RESULTS: 154 patients who encountered 170 episodes of serious events necessitating TA were evaluated across 76 studies. Among them, 51% were males, with a mean age ranging from 49 to 58 years. The CV types included 15 type I, 97 type II, and 13 type III, while the remaining patients exhibited mixed (n = 17) or undetermined CV types (n = 12). Among the treatment modalities, PE, PP, and CF were performed in 85 (56%), 52 (34%), and 17 patients (11%), respectively, with no identical protocol for TA treatment. The overall response rate for TA was 78%, with response rates of 84%, 77%, and 75% observed in type I, II, and III patients respectively. Most patients received steroids, immunosuppressants, and treatment targeting the underlying causative disease. The overall long-term renal outcome rate was 77%, with type I, II, and III patients experiencing response rates of 89%, 76%, and 90%, respectively. The renal outcomes in patients receiving PE, PP, and CF were comparable, with rates of 78%, 76%, and 81%, respectively.
CONCLUSIONS: This study presents compelling evidence that combination of TA with other treatments, especially immunosuppressive therapy, is a successful strategy for effectively managing severe renal involvement in CV patients. Among the TA modalities studied, including PE, PP, and CF, all demonstrated efficacy, with PE being the most frequently employed approach.
摘要：
背景：治疗性单采（TA）通常用于冷球蛋白性血管炎（CV）患者，但其疗效仍不确定。本系统综述旨在评估不同TA模式的疗效，如血浆置换（PE），血浆置换（PP），和低温过滤（CF），在治疗有肾脏受累的CV患者中。
方法：MEDLINE文献检索，EMBASE,和Cochrane数据库进行到2022年12月。评估了报告有肾脏受累的成年CV患者的TA结局的研究。此系统审查的方案已在PROSPERO注册（编号：CRD42023417727）。研究人员使用经过验证的非随机研究（未成年人）质量评分的方法学指标对每项研究的质量进行评估。
结果：在76项研究中评估了154例严重事件需要TA发作的患者。其中,51%是男性,平均年龄从49岁到58岁。CV类型包括15个I型，97II型，和13型III，而其余患者表现为混合（n=17）或未确定的CV类型（n=12）。在治疗方式中，PE,PP,和CF在85（56%）中进行，52（34%），17名患者（11%），分别,没有相同的TA治疗方案。TA的总有效率为78%，反应率为84%，77%,在I型中观察到75%，II,和III患者分别。大多数病人接受了类固醇,免疫抑制剂,以及针对潜在致病疾病的治疗。总的长期肾脏转归率为77%,I型,II,III患者的反应率为89%，76%,90%,分别。接受PE的患者的肾脏结局，PP,和CF相当，率为78%，76%,81%,分别。
结论：这项研究提供了令人信服的证据，表明TA与其他治疗方法的组合，尤其是免疫抑制疗法,是有效管理CV患者严重肾脏受累的成功策略。在研究的TA模式中，包括PE,PP,CF,都证明了功效，PE是最常用的方法。
方法：MEDLINE文献检索，EMBASE,和Cochrane数据库进行到2022年12月。评估了报告有肾脏受累的成年CV患者的TA结局的研究。此系统审查的方案已在PROSPERO注册（编号：CRD42023417727）。研究人员使用经过验证的非随机研究（未成年人）质量评分的方法学指标对每项研究的质量进行评估。
结果：在76项研究中评估了154例严重事件需要TA发作的患者。其中,51%是男性,平均年龄从49岁到58岁。CV类型包括15个I型，97II型，和13型III，而其余患者表现为混合（n=17）或未确定的CV类型（n=12）。在治疗方式中，PE,PP,和CF在85（56%）中进行，52（34%），17名患者（11%），分别,没有相同的TA治疗方案。TA的总有效率为78%，反应率为84%，77%,在I型中观察到75%，II,和III患者分别。大多数病人接受了类固醇,免疫抑制剂,以及针对潜在致病疾病的治疗。总的长期肾脏转归率为77%,I型,II,III患者的反应率为89%，76%,90%,分别。接受PE的患者的肾脏结局，PP,和CF相当，率为78%，76%,81%,分别。
结论：这项研究提供了令人信服的证据，表明TA与其他治疗方法的组合，尤其是免疫抑制疗法,是有效管理CV患者严重肾脏受累的成功策略。在研究的TA模式中，包括PE,PP,CF,都证明了功效，PE是最常用的方法。
