Apheresis With Prosorba Column An Option in Refractory Rheumatoid
Arthritis Cases


WESTPORT, Oct 25 (Reuters Health) - Apheresis via the Prosorba column is safe and effective in patients with active, treatment-resistant rheumatoid arthritis (RA). That's according to results of a multicenter,
randomized, double-blind, sham-controlled trial.

Dr. David T. Felson of Boston University Arthritis Center, Massachusetts, and colleagues describe the trial in the October issue of the journal Arthritis and Rheumatism. They randomized 91 patients with
longstanding active RA who had failed methotrexate or at least two other second-line agents to sham apheresis or to apheresis with the Prosorba column once per week for 12 weeks. They followed the patients for an
additional 7 to 8 weeks.

The benefits of the Prosorba column over sham apheresis were so evident that the data safety monitoring board halted the trial early. "To our knowledge, this is the first trial in RA patients (or, in rheumatology
in general) that has been stopped by a [data safety monitoring board]," the investigators note in the paper.

Specifically, Dr. Felson and colleagues report that 31.9% of the 44 patients randomized to the Prosorba column showed improvement according to American College of Rheumatology (ACR) criteria, compared with only 11.4% of the 44 patients randomized to sham apheresis.

There were no significant between-group differences in terms of side effects, according to the researchers. The most common side effect, a "...short-term flare in joint pain and swelling," occurred at least once following treatment in most patients in both the Prosorba column and the sham arm.

While the precise mechanism of action of the Prosorba column is not known, preliminary studies suggest that the Prosorba column removes "...relatively small amounts of immunoglobulin," the investigators say.

Dr. Felson and colleagues call for further study to determine how long the efficacious effects of treatment last and how often patients may need to undergo apheresis with the Prosorba column.

Arthritis Rheum 1999;42:2153-2159.

Copyright © 1994-1999 by Medscape Inc.

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