Current Knowledge on the Impact of Extracorporeal Blood Purification Devices on Drug Clearance - Systematic Search & Narrative Review.

Introduction Extracorporeal blood purification (EBP) devices are increasingly used in critically ill patients to manage sepsis, hyperinflammatory states, and other life-threatening conditions. However, these devices may unintentionally remove therapeutic medications, potentially compromising efficacy. Understanding these interactions is essential to optimize therapy and ensure patient safety. Methods A systematic search of PubMed, Cochrane, and manufacturer-specific databases was performed to identify literature on drug removal by current adsorptive EBP devices. Studies were screened for evidence of drug clearance, including both preclinical and clinical (in-vivo) data, using specific keywords related to drug removal and therapeutic drug monitoring (TDM). Results Out of 659 identified articles, 61 met the inclusion criteria. CytoSorb was the most extensively studied device, with 25 relevant publications-19 of which included in-vivo data. Data on drug removal were found for 43 substances with CytoSorb, 8 with Jafron, 12 with oXiris, 25 with Seraph, and 13 with PMX-HP. Antibiotics were the most commonly studied drug class, with vancomycin and meropenem being the most frequently investigated agents. While CytoSorb had the most comprehensive data, evidence for other devices was limited, especially regarding clinical studies. Conclusions Adsorptive EBP devices have the potential to unintentionally remove medications, which may compromise therapeutic effectiveness in critically ill patients if not properly accounted for. Among currently available devices, CytoSorb has the most comprehensive evidence base. However, additional clinical studies are required for all devices to confirm findings and establish dosing recommendations. The use of therapeutic drug monitoring, when available, is strongly advised to guide clinical decision-making.  .