Types of plasma exchange solution in the new scenario of thrombotic thrombocytopenic purpura treatment

Abstract

PREVIEW

Dear Sir,

In response to the Letter to the Editor by the group of Parra-Salinas¹ about our article published in this Journal² we would like to make the following clarifications.

We are aware that the type of plasma used in therapeutic plasma exchange (TPE) was a subject of controversy in the past, especially in our country, when plasma exchange and corticosteroids were the only treatment for thrombotic thrombocytopenic purpura. However, the latest significant advances in the understanding of the physiopathology of immune-mediated thrombotic thrombocytopenic purpura have changed the approach to and management of this disease, improving its course.

Although the gold-standard therapy continues to be the front-line treatment for strongly suspected immune thrombotic thrombocytopenic purpura, the TITAN³ and HERCULES⁴ studies published in 2016 and 2019, respectively, and their integrated analysis demonstrated a 33.3% reduction in the median number of days of TPE⁵. This fact established a completely new management strategy that we could not deny in our discussions and final consensus.  [ … ]