Immunotherapy With Subcutaneous Immunoglobulin or Plasmapheresis in Patients With Postural Orthostatic Tachycardia Syndrome (POTS)

Objective To assess improvement in autonomic symptoms and functional impairment following immunotherapy with subcutaneous immunoglobulin (SCIG) or plasmapheresis (PLEX) patients postural orthostatic tachycardia syndrome (POTS). Background POTS is a common disorder defined by an increased heart rate of at least 30 bpm within 10 minutes standing tilt table test, accompanied intolerance, fatigue, dizziness, headache. Despite pharmacologic non-pharmacologic therapy, the marked associated reflects great need for improved treatment. Autoimmunity has emerged as leading etiology POTS, case series describing successful treatment IVIG. our knowledge, SCIG not been described previously. Design/Methods Clinical history seven treated PLEX was reviewed. Response to assessed using COMPASS-31 ability scale (FAS) completed retrospectively pre- 3-12 months post-treatment PLEX. Patients comorbid autoimmune disorders immune deficiency requiring were excluded from study. Results Of patients, all female, ages 28-57, five received two Four had small fiber neuropathy various positive antibodies low titers. Across FAS scores average 50% 217%, respectively. Six able discontinue reduce oral medications reported being return work school. No serious adverse events reported. Conclusions experienced significant reduction This suggests that may be safe effective treatments severe refractory standard therapies. Randomized controlled trials are needed determine efficacy safety these long-term