Comparison of ANCA and Anti-GBM Auto-antibodies Removal Kinetics Between Plasma Exchanges and Immunoadsorption in Patients With ANCA-associated Vasculitis or Anti-GBM Disease
Comparison of ANCA and Anti-GBM Auto-antibodies Removal Kinetics Between Plasma Exchanges and Immunoadsorption in Patients With ANCA-associated Vasculitis or Anti-GBM Disease
Anti-neutrophil cytoplasmic antibodies (ANCA), directed against myeloperoxidase (MPO) and
 against proteinase 3 (PR3), have a pathogenic role during ANCA (AAV) vasculitis. Glomerular
 basement membrane (MBG) antibodies also have a direct pathogenic role in Goodpasture's
 syndrome and anti-MBG antibody glomerulonephritis (GN). In some patients, the severity of
 renal and / or pulmonary involvement justifies the rapid purification of these autoantibodies
 by an apheresis procedure, while waiting for the effect of immunosuppressive treatments aimed
 at reducing their production. During vasculitis, plasma exchange (PE) is recommended in
 patients with severe renal impairment or intra-alveolar hemorrhage (2012 KDIGO Clinical
 Practice Guideline for Glomerulonephritis).

 Given certain disadvantages related to plasma exchanges (low volume of purified plasma,
 non-selective technique for immunoglobulins (Ig), need for replacement solute, induction of
 coagulation disorders), immunoadsorption (IA), already used in transplantation, has been
 developed in these indications. IA has indeed greater selectivity for Ig with a probable
 better purification capacity due to higher volumes of plasma treated per session. The price
 of IA is however higher than that of EP.

 These two apheresis techniques, EP and IA, are commonly used in France during severe forms of
 vasculitis ANCA or anti-MBG, without the superiority of one or the other has been
 demonstrated. As a result of higher plasma volumes being purified, AI may allow faster
 purification of pathogenic antibodies. No studies to date have specifically compared the
 purification kinetics of these antibodies between EP and IA.

 The CINEVAS study (VAScularite Antibody Purification CINetic) is a multicentric pilot study
 whose main objective is to compare the purification kinetics of ANCA (anti-MPO or anti-PR3)
 and / or anti- MBG in patients treated with EP versus those treated with IA
Inclusion Criteria:

 -  Age ≥ 18 years

 -  Patient with ANCA vasculitis with positive anti-MPO or anti-PR3 antibodies, or patient
 with Goodpasture syndrome or anti-MBG antibody glomerulonephritis

 -  Patient for whom the investigating physician retains the indication of apheresis

 -  Induction treatment with corticosteroids and cyclophosphamide or rituximab

 Exclusion Criteria:

 -  Pregnancy or breastfeeding

 -  Vasculitis without anti-MPO, anti-PR3 or anti-MBG

 -  Severe anemia (hemoglobin <7 g / dL) contraindicates additional blood sampling