ANTIBODY DEPLETION AND CYTOTOXIC DRUG-THERAPY IN SEVERE SYSTEMIC LUPUS-ERYTHEMATOSUS

The established treatment of severe systemic lupus erythematosus (SLE) includes corticosteroids and cytotoxic drugs. Therapeutic plasmapheresis may provide additional rapid relief, but this is only temporary. Controlled trials have repeatedly demonstrated that long-term improvement cannot be achieved if plasmaphereses are performed in addition to long-term oral immunosuppression, as is the usual procedure. This might be an indication that the organism has a considerable ability to re-establish the status quo ante. By contrast, uncontrolled case reports indicate that both rapid and long-term benefits may be achieved by combining plasmapheresis with subsequent pulses of an alkylating agent. The approach used in these studies theorizes that antibody depletion induces increased proliferation of pathogenic clones and that it should be possible to exploit this increased proliferation for the enhanced deletion of pathogenic clones by the subsequent application of pulse cyclophosphamide. The present paper reviews the literature and summarizes the results achieved with the treatment of severe SLE using cytotoxic agents and antibody elimination. Additionally, the authors discuss how the organism's ability to achieve rapid counterregulation might be utilized to improve the therapeutic results, and they attempt to develop perspectives for the future.