Clinical efficacy of plasma exchange in systemic lupus erythematosus during pregnancy

ObjectiveTo investigate the clinical efficacy of plasma exchange (PE) with or without prednisone and hydroxychloroquine (HCQ) for the treatment of systemic lupus erythematosus (SLE) during pregnancy.MethodsThe clinical characteristics of 14 pregnant women with SLE admitted to our hospital were retrospectively analyzed, including 7 only treated with prednisone and HCQ (non-PE group) as well as 7 combined PE (PE group). The delivery situations of 14 patients were recorded. Data like erythrocyte sedimentation rate (ESR), urine protein, platelet count, and SLEDAI scores were compared between two groups before treatment and 3, 6, and 12 months after delivery.ResultsThree patients in the non-PE group ended in miscarriage while all patients in the PE group were delivered successfully. Eleven successfully delivered fetuses in the two groups were healthy, and the Apgar scores were over 8. The ESR of the PE group was significantly lower than that of the non-PE group at 6 and 12 months after delivery, while there was no statistical difference in ESR between the two groups before treatment and 3 months after delivery. The ESR and urine protein were significantly higher in the non-PE group at months 3, 6, and 12 postpartum. There was a significant decrease in disease activity postpartum in the PE group compared to predelivery disease activity. The change in platelet counts between the two groups significantly increased over time in the PE group, while SLEDAI scores decreased.ConclusionsThe combination of PE and oral prednisone and HCQ is possibly a more effective treatment than oral prednisone and HCQ alone for patients with active SLE during pregnancy. This treatment option reduces pregnancy loss and promotes the patients' postpartum condition to a certain extent. In this study, we recruit 14 SLE patients to analyze the clinical efficacy of prednisone and HCQ alone or in combination with PE for the treatment of SLE during pregnancy. The data showed that PE in the combination of PE and oral prednisone and HCQ is a more effective treatment than oral prednisone and HCQ alone for patients with active SLE during pregnancy. This treatment option reduces pregnancy loss and promotes the patients' postpartum condition.Key messagesimage Systemic lupus erythematosus (SLE) is a complicated autoimmune disease, that leads to an increased probability of pregnancy loss and adverse pregnancy outcomes. The use of a small number of immunosuppressants and biological agents during pregnancy probably puts the fetuses' of SLE at risk for teratogenesis. This dramatically limits drug treatment during pregnancy. Plasmapheresis (PE) can effectively remove pathogenic substances in plasma with high molecular weights, such as autoantibodies, immune complexes, and cryoglobulin. In our study, the combination of PE and oral prednisone and HCQ may be a more effective treatment than oral prednisone and HCQ alone for patients with active SLE during pregnancy. To a certain extent, this treatment option reduces pregnancy loss and promotes the patients' postpartum condition.