Lipoprotein apheresis remains an effective treatment for lowering LDL and Lp(a) in patients with severe atherosclerosis, though emerging lipid-lowering drugs may alter its future clinical role.
Since the 1980s, several lipoprotein apheresis methods that eliminate atherogenic lipoproteins (LDL and lipoprotein(a) Lp(a)) have been developed. These methods are based on the following principles: precipitation, adsorption and filtration. In Dresden (Germany), we started to perform extracorporeal treatment in 1990; in the 1980s we were working as a lipidologic center and saw patients dying due to severe atherosclerotic diseases. At present, 80 patients are being treated with six different methods at the Apheresis center at the University Hospital Dresden. The effectiveness of these methods with respect to lowering of LDL cholesterol and Lp(a) is somewhat different. The number of patients with high Lp(a) levels and with severe atherosclerotic complications has increased steadily since 2008. Several studies have shown a high effectiveness for apheresis treatment in these patients. In the future, new drugs (e.g., lomitapide, mipomersen or PCSK9 inhibitors) will probably modify the position of apheresis in the therapeutic regimen.
Julius et al. (Thu,) studied this question.
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