Apherese Forschungsinstitut

ZUSAMMENFASSUNGInsbesondere die schwere Hypertriglyzeridämie (SHTG) führt zu einem erhöhten Risiko für eine besonders schwer verlaufende Pankreatitis. In der Akutsituation einer SHTG-Pankreatitis müssen die Triglyzeride sehr rasch gesenkt werden, um einen weiteren Organschaden zu verhindern. Mithilfe der therapeutischen Apherese in Form des Plasmaaustausches oder der Doppelfiltrations-Plasmapherese (DFPP) gelingt dies effektiv und sicher. Für Patienten mit rezidivierender SHTG-Pankreatitis kann eine Langzeittherapie mit Apherese zusätzlich zu Diät, Lebensstilmaßnahmen und medikamentöser Therapie ein wichtiges Therapiemodul zur Prävention erneuter Ereignisse sein. In der Schwangerschaft ist jede zweite Pankreatitis durch zu hohe Triglyzeride verursacht. Bei fortbestehender Fettstoffwechselstörung kann die therapeutische Apherese eine Therapieoption sein, um ein solches für den Fötus und die Mutter lebensbedrohliches Ereignis zu verhindern.

Approximately 25 % of women with multiple sclerosis (MS) suffer clinically relevant relapses during pregnancy. Almost all disease-modifying drugs are contraindicated in pregnancy. High-dose glucocorticoids have some serious risks, especially within the first trimester. Tryptophan immunoadsorption (IA) provides a safe option to treat MS relapses during pregnancy. In this case series we describe for the first time the use of tryptophan IA for MS and neuromyelitis optica (NMO) relapses during pregnancy and breastfeeding. In this study a total of 9 patients were retrospectively analyzed of which 7 patients received IA treatment during pregnancy, 2 during breastfeeding and 4-6 tryptophan IA treatments were performed per patient with the single use tryptophan adsorber. Primary outcome was symptom improvement of the relapse. In this study four patients with MS and one with NMO relapse during pregnancy were treated with IA without preceding glucocorticoid pulse therapy. The MS patients showed improvement in the expanded disability status scale (EDSS) by at least one point, the NMO patient showed significant improvement in visual acuity and two pregnant patients with steroid-refractory relapses showed clinically relevant improvement after IA. Of the patients two suffered from steroid-refractory relapses during breastfeeding and relapse symptoms improved in both cases after treatment with IA. All treatments were well tolerated and no serious adverse events occurred. Tryptophan IA was found to be safe, well-tolerated and effective in the treatment of MS and NMO relapses during pregnancy and breastfeeding, sometimes without preceding glucocorticoid pulse therapy. A binding recommendation is limited without prospective clinical studies.