Plasma Exchange May Help Ease Scleroderma’s Digestive Symptoms
Therapeutic plasma exchange may help ease digestive issues in people with limited systemic scleroderma (lcSSc), new research indicates.
Edward Harris of the Scleroderma Education Project presented the findings at the American Society for Apheresis (ASFA) annual meeting in Philadelphia earlier this month, in a poster titled, “The Effects Of Pulsed Therapeutic Plasma Exchange On Gastrointestinal Symptoms In Limited Systemic Sclerosis: A Case Series.”
Therapeutic plasma exchange, or TPE, involves taking out a person’s blood, separating the cells from the noncellular portion (plasma), and then mixing the cells with a plasma substitute before infusing them back into the body. The procedure aims to filter out disease-driving inflammatory proteins and self-reactive antibodies in plasma.
There have not been any clinical trials to rigorously test TPE in people with scleroderma, but prior research — including work led by Harris — has indicated that TPE may ease scleroderma symptoms such as digital ulcers and Raynaud’s phenomenon.
Harris presented data from four people with limited scleroderma who were treated with TPE. All received one blood volume TPE treatment per week for four weeks, with eight weeks of no treatment between each four-week treatment cycle — called pulsed plasma exchange (PPE). A solution of 4% to 5% albumin (a blood protein) was used as the plasma substitute.
The procedure was generally well tolerated. “No significant adverse events [side effects] related to TPE treatments were reported in any patient,” the researchers wrote. The most common treatment-related problem was anemia due to low iron levels, which could be managed with over-the-counter iron supplements.
The first patient described in the poster started on TPE in 1993, and has undergone nearly 500 treatments to date. The other three patients all started between 2019–2020, and each has undergone a few dozen treatments.
Prior to starting on TPE, all patients had notable digestive symptoms. For example, all four reported gastro-esophageal reflux disease (GERD, called acid reflux).
In all four patients, at least some of these symptoms eased after starting on TPE. For instance, the patient who had been on TPE since 1993 had no remaining GERD after decades on TPE.
Among the three patients treated since 2019, one saw GERD ease substantially, and another, with dysphagia (difficulty swallowing), found that swallowing was easier after a few months of TPE. Both patients reported that TPE eased throat spasms.
The remaining patient had anemia related to a digestive condition called Gastric Antral Vascular Ectasia (GAVE) prior to TPE. Since starting TPE in 2019, she has maintained normal levels of hemoglobin — a protein that carries oxygen in red blood cells — without additional treatment, though she still had GERD and other disease symptoms at the time of the presentation.
“These preliminary results suggests that PPE should be considered in lcSSc patients with significant GI [gastrointestinal] symptoms,” the researchers concluded.
The researchers emphasized that additional research is needed to understand how plasma exchange may benefit scleroderma patients, but they noted the findings are particularly striking because available immune-suppressing treatments for scleroderma have little effect on digestive symptoms.
“Treatment for GI involvement in [systemic scleroderma] is almost entirely focused on symptom relief as conventional immunosuppressive treatments do not reduce the likelihood of developing severe GI symptoms,” the scientists wrote.
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