Extracorporeal photochemotherapy for the treatment of lupus erythematosus: preliminary observations

Abstract

Systemic lupus erythematosus (SLE) is a T cell-mediated disease for which a highly specific therapy is not available [1, 5, 14, 15]; thus, nonspecific immunosuppressive therapy including corticosteroids and/or cytotoxic drugs is repeatedly required to control the disease. As is well known these drugs can lead to limiting side effects and complications [5, 7]. In the past few years extracorporeal photochemotherapy (ECP) of circulating blood leukocytes was described as a new and seemingly effective method of immunomodulation [2, 4, 6, 9, 11, 18, 19, 20]. Under ECP, low-energy ultraviolet A (UVA) irradiation of peripheral blood leukocytes takes place after addition of the photoactivatable drug 8-methoxypsoralen (8-MOP). Subsequent reinfusion of such photomodified leukocytes is considered to initiate a modulation of the immune system. Even though the exact mechanisms underlying the clinical responses reported with ECP have not been unraveled, encouraging clinical effects with ECP have been documented in treating human cutaneous T cell lymphoma [6, 10, 11], pemphigus vulgaris [20], progressive systemic sclerosis [19], AIDS-related complex [4], and cardiac transplant patients in an acute and chronic rejection phase (on-going multicenter clinical trials). As reported [12, 13] an open 2-year clinical trial on ten patients was performed to evaluate the safety, feasibility and efficacy of ECP in the management and treatment of SLE.