Feasibility, safety, and tolerability of two modalities of plasma exchange with albumin replacement to treat elderly patients with Alzheimer's disease in the AMBAR study.

Abstract

BACKGROUND:

In the Alzheimer Management by Albumin Replacement (AMBAR) study, mild-to-moderate Alzheimer's disease (AD) patients were treated with a plasma exchange (PE) program. Feasibility and safety of PE in this specific population are poorly understood and were analyzed in detail in this study.

METHODS:

Qualified patients were treated with 6 weeks of weekly conventional therapeutic plasma exchange (TPE) with albumin replacement followed by monthly low-volume plasma exchange (LVPE) for 12 months. The patients were divided into four groups: placebo (sham PE treatment), low-albumin (20 g), low-albumin + intravenous immunoglobulin (IVIG) (10 g), and high-albumin (40 g) + IVIG (20 g). Adverse events (AEs) were recorded and analyzed for all PE treatment groups and PE modalities.

RESULTS:

PE procedure-related AEs were more common in the active treatment groups (16.9% out of 1283 TPE and 12.5% out of 2203 LVPE were associated with at least one AE, a similar rate than in other PE indications) than in the placebo group (0.7% out of 1223 sham PE). Percentage of procedures with at least one AEs was higher with central venous access compared to peripheral venous access in all three active treatment groups (20.1% vs 13.1%, respectively).

CONCLUSION:

The TPE and LVPE procedures used in the AMBAR study on mild-to-moderate AD population were as safe and feasible as in other therapeutic applications of PE or routine plasmapheresis.

• Authors: Mercè Boada, Dobri Kiprov, Fernando Anaya, Oscar L López, Laura Núñez, Javier Olazarán, José Lima, Carlota Grifols, Miquel Barceló, Regina Rohe, Cristina Prieto-Fernández, Zbigniew M Szczepiorkowski, Antonio Páez
• Journal: Journal of clinical apheresis (J Clin Apher) Vol. 38 Issue 1 Pg. 45-54 (Feb 2023) ISSN: 1098-1101 [Electronic] United States
• PMID: 36305459 (Publication Type: Journal Article)
• Copyright: © 2022 The Authors. Journal of Clinical Apheresis published by Wiley Periodicals LLC.

Chemical References

• Albumins
• Immunoglobulins, Intravenous

Topics

• Aged
• Humans
• Albumins (therapeutic use)
• Alzheimer Disease (chemically induced, drug therapy)
• Feasibility Studies
• Immunoglobulins, Intravenous (therapeutic use)
• Plasma Exchange (adverse effects, methods)
• Plasmapheresis (methods)