Evaluation of Hemoadsorption Capacity of the <scp>CytoSorb</scp> Adsorber for Toxic Doses of Diclofenac and Meloxicam in Porcine Plasma

The objective of this in vitro experimental was to determine the utility of hemoadsorption (HA) using the CytoSorb adsorber to remove meloxicam and diclofenac from porcine plasma. For this purpose 12 1-L aliquots of porcine plasma, 6 units were spiked with 293 μg/mL (262-320 μg/mL) diclofenac and 6 with 42.8 μg/mL (41.4-44.7 μg/mL) meloxicam, respectively. Each unit was processed in a circular setup with the CytoSorb adsorber using the PuriFi HA platform until a recirculated volume of 20 L was reached. Pre- and post-adsorber samples were obtained at seven time points. Percentage reduction, clearance, and change from baseline were calculated. Drug concentrations were compared using Friedmann test with post hoc Dunn's multiple comparison test and Wilcoxon matched pairs rank sum test. p < 0.05 were considered significant. Diclofenac was reduced by a median of 242 mg (204-262 mg; 82.1%; 77.0%-83.6%). Total clearance was 40.5 mL/min (33.2-46.2 mL/min). Clearance at a plasma flow of 100 mL/min decreased from 39.9 mL/min (25.3-46.6 mL/min) at 0.2 L to 6.4 mL/min (-3.8 to 14.8 mL/min) at 20 L. Median reduction of meloxicam was 40.4 mg (38.6-42.2 mg; 94.4%; 93.2%-94.6%); total clearance was 94.38 mL/min (93.2-94.6 mL/min). Clearance at a plasma flow of 100 mL/min decreased from 65.3 mL/min (56.7-71.7 mL/min) at 0.2 L to 3.6 mL/min (-13.0 to 4.2 mL/min) at 20 L. HA using the CytoSorb adsorber successfully removed meloxicam and diclofenac from porcine plasma.