State of the Evidence: Drug Removal via Apheresis

• Published in: Transfusion medicine reviews Vol. 37; no. 1; pp. 16 - 20
• Main Authors: Binns, Thomas C, Sostin, Nataliya, Tormey, Christopher A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2023
• Subjects: Apheresis; Blood Component Removal - methods; Dosing; Drug removal; Erythrocytes; Humans; Overdose; Pharmacokinetics; Plasmapheresis; Dosing; RBC; RBCX; Apheresis; Drug removal; TPE; Overdose; Pharmacokinetics; PML; Plasmapheresis; mAb
• ISSN: 0887-7963; 1532-9496; 1532-9496
• DOI: 10.1016/j.tmrv.2022.12.003

•Drug removal by apheresis depends upon agent, patient, and procedure variables.•Evidence should be interpreted in the context of study generalizability and design.•As new drug types enter the market, additional study on this topic will be needed. Therapeutic apheresis refers to a diversity of procedures in which specific hematologic components (e.g., plasma, erythrocytes, leukocytes, etc.) with pathological associations are removed from circulation (with possible replacement) in order to treat a variety of disease processes. As pharmacologic agents also circulate with these components, their removal is sometimes incidental, or in the scenario of drug toxicity, a therapeutic goal. The corpus of published manuscripts on this subject has grown immensely over the past few decades; however, the breadth of diseases, methods, and drugs that co-exist in this space make it challenging to generate generalizable evidence regarding drug removal via apheresis. This review discusses factors worth considering when interpreting literature-reported data on drug removal by apheresis with examples from several notable studies and highlights topics in need of evidential improvement and growth as our palette of therapeutic agents continues to expand.