Correlates of survival after autoantibody reduction therapy for acute IPF exacerbations.

<h4>Background</h4>No medical treatment has proven efficacy for acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF), and this syndrome has a very high mortality. Based on data indicating humoral autoimmune processes are involved in IPF pathogenesis, we treated AE-IPF patients w...

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Autores principales:	Tejaswini Kulkarni, Vincent G Valentine, Fei Fei, Thi K Tran-Nguyen, Luisa D Quesada-Arias, Takudzwa Mkorombindo, Huy P Pham, Sierra C Simmons, Kevin G Dsouza, Tracy Luckhardt, Steven R Duncan
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/85f900e1784f4301bb0c8b174ccf412b
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spelling	oai:doaj.org-article:85f900e1784f4301bb0c8b174ccf412b2021-12-02T20:16:13ZCorrelates of survival after autoantibody reduction therapy for acute IPF exacerbations.1932-620310.1371/journal.pone.0260345https://doaj.org/article/85f900e1784f4301bb0c8b174ccf412b2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0260345https://doaj.org/toc/1932-6203<h4>Background</h4>No medical treatment has proven efficacy for acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF), and this syndrome has a very high mortality. Based on data indicating humoral autoimmune processes are involved in IPF pathogenesis, we treated AE-IPF patients with an autoantibody reduction regimen of therapeutic plasma exchange, rituximab, and intravenous immunoglobulin. This study aimed to identify clinical and autoantibody determinants associated with survival after autoantibody reduction in AE-IPF.<h4>Methods</h4>Twenty-four(24) AE-IPF patients received the autoantibody reduction regimen. Plasma anti-epithelial autoantibody titers were determined by HEp-2 indirect immunofluorescence assays in 22 patients.<h4>Results</h4>Mean age of the patients was 70 + 7 years old, and 70% were male. Beneficial clinical responses that occurred early during therapy were a favorable prognostic indicator: supplemental O2 flows needed to maintain resting SaO2>92% significantly decreased and/or walk distances increased among all 10 patients who survived for at least one year. Plasma anti-HEp-2 autoantibody titers were ~-three-fold greater in survivors compared to non-survivors (p<0.02). Anti-HEp-2 titers >1:160 were present in 75% of the evaluable one-year survivors, compared to 29% of non-survivors, and 10 of 12 patients (83%) with anti-HEP-2 titers <1:160 died during the observation period (Hazard Ratio = 3.3, 95% Confidence Interval = 1.02-10.6, p = 0.047).<h4>Conclusions</h4>Autoantibody reduction therapy is associated with rapid reduction of supplemental oxygen requirements and/or improved ability to ambulate in many AE-IPF patients. Facile anti-epithelial autoantibody assays may help identify those most likely to benefit from these treatments.Tejaswini KulkarniVincent G ValentineFei FeiThi K Tran-NguyenLuisa D Quesada-AriasTakudzwa MkorombindoHuy P PhamSierra C SimmonsKevin G DsouzaTracy LuckhardtSteven R DuncanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11, p e0260345 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Tejaswini Kulkarni Vincent G Valentine Fei Fei Thi K Tran-Nguyen Luisa D Quesada-Arias Takudzwa Mkorombindo Huy P Pham Sierra C Simmons Kevin G Dsouza Tracy Luckhardt Steven R Duncan Correlates of survival after autoantibody reduction therapy for acute IPF exacerbations.
description	<h4>Background</h4>No medical treatment has proven efficacy for acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF), and this syndrome has a very high mortality. Based on data indicating humoral autoimmune processes are involved in IPF pathogenesis, we treated AE-IPF patients with an autoantibody reduction regimen of therapeutic plasma exchange, rituximab, and intravenous immunoglobulin. This study aimed to identify clinical and autoantibody determinants associated with survival after autoantibody reduction in AE-IPF.<h4>Methods</h4>Twenty-four(24) AE-IPF patients received the autoantibody reduction regimen. Plasma anti-epithelial autoantibody titers were determined by HEp-2 indirect immunofluorescence assays in 22 patients.<h4>Results</h4>Mean age of the patients was 70 + 7 years old, and 70% were male. Beneficial clinical responses that occurred early during therapy were a favorable prognostic indicator: supplemental O2 flows needed to maintain resting SaO2>92% significantly decreased and/or walk distances increased among all 10 patients who survived for at least one year. Plasma anti-HEp-2 autoantibody titers were ~-three-fold greater in survivors compared to non-survivors (p<0.02). Anti-HEp-2 titers >1:160 were present in 75% of the evaluable one-year survivors, compared to 29% of non-survivors, and 10 of 12 patients (83%) with anti-HEP-2 titers <1:160 died during the observation period (Hazard Ratio = 3.3, 95% Confidence Interval = 1.02-10.6, p = 0.047).<h4>Conclusions</h4>Autoantibody reduction therapy is associated with rapid reduction of supplemental oxygen requirements and/or improved ability to ambulate in many AE-IPF patients. Facile anti-epithelial autoantibody assays may help identify those most likely to benefit from these treatments.
format	article
author	Tejaswini Kulkarni Vincent G Valentine Fei Fei Thi K Tran-Nguyen Luisa D Quesada-Arias Takudzwa Mkorombindo Huy P Pham Sierra C Simmons Kevin G Dsouza Tracy Luckhardt Steven R Duncan
author_facet	Tejaswini Kulkarni Vincent G Valentine Fei Fei Thi K Tran-Nguyen Luisa D Quesada-Arias Takudzwa Mkorombindo Huy P Pham Sierra C Simmons Kevin G Dsouza Tracy Luckhardt Steven R Duncan
author_sort	Tejaswini Kulkarni
title	Correlates of survival after autoantibody reduction therapy for acute IPF exacerbations.
title_short	Correlates of survival after autoantibody reduction therapy for acute IPF exacerbations.
title_full	Correlates of survival after autoantibody reduction therapy for acute IPF exacerbations.
title_fullStr	Correlates of survival after autoantibody reduction therapy for acute IPF exacerbations.
title_full_unstemmed	Correlates of survival after autoantibody reduction therapy for acute IPF exacerbations.
title_sort	correlates of survival after autoantibody reduction therapy for acute ipf exacerbations.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/85f900e1784f4301bb0c8b174ccf412b
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Correlates of survival after autoantibody reduction therapy for acute IPF exacerbations.

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