The Prosorba Column, also known as Protein-A Immunoadsorption Therapy, is a plastic cylinder containing a sand-like substance coated with a special material called protein A. It was FDA approved in March of 1999 for the treatment of rheumatoid arthritis. The Prosorba Column had been approved in 1987 to treat idiopathic thrombocytopenic purpura.
The cylinder is used with a procedure known as apheresis. Blood is drawn from your arm and passes through a machine that separates plasma from blood cells. The plasma passes through the Prosorba Column, where antibodies (which play a role in rheumatoid arthritis) are removed. The plasma which has the antibodies removed and the blood cells are mixed back together and returned to the patient through a vein in the opposite arm.
Usual Course of Prosorba
Prosorba treatment is rarely used, but when it is, the usual course of treatment involves twelve weekly outpatient sessions that take approximately two hours. It is only considered for patients with moderate to severe rheumatoid arthritis who have failed DMARDs or biologics.
In clinical trials, 30 percent to 40 percent of patients benefited from the Prosorba Column and some achieved remission that lasted for a year or longer.
The Prosorba Column procedure is contraindicated in patients taking ACE inhibitors for blood pressure or heart disease unless the patient undergoes a seventy-two-hour withdrawal period for the ACE inhibitor. Discuss it with your doctor if you take an ACE inhibitor.
Cost and Insurance Coverage
The procedure is classified as a medical device, not a drug. Medicare covers the procedure for severe rheumatoid arthritis patients with active disease, which is defined as having: more than five swollen joints, more than twenty tender joints, and morning stiffness lasting more than one hour. In order to be covered by Medicare, patients also must have failed three or more DMARDs. Failure is specified as an insufficient response, not as intolerance. Medicaid and most private insurance companies cover the procedure, but may have some restrictions. As always, you should check with your own insurance to be certain. The twelve-week course of Prosorba carries a hefty price tag of $18,000 or more.
What Else Should You Know about Prosorba?
Prosorba is not as well-known as other rheumatoid arthritis treatments. Here are some other important facts you should know before being treated with Prosorba:
Some patients who responded to the Prosorba Column noticed results after six weeks, while others took more than twenty weeks.
Twenty minutes prior to Prosorba treatment, you should do arm bends using one pound hand weights, use a rubber ball to perform hand squeezes, or apply heat to promote circulation.
Drink plenty of fluids (caffeine free) the day before and day of treatment with Prosorba.
The veins used for the Prosorba treatment should not be used for blood drawing during the course of the twelve-week treatment.
It is not unusual for you to feel flu-like symptoms after treatment, but usually the symptoms are mild and temporary. Patients also report having symptoms like an arthritis flare after treatment (such as fatigue, joint pain, and swelling). Patients with a past history of infection or blood clotting problems need to mention that to their doctor. Patients with severe heart or lung disease or who have had recent surgery may not be candidates for Prosorba.