[Info] Intravenous Immune Globulin (IVIG) Therapy

[RobinN]

High-dose intravenous immune globulin (IVIg) has emerged as an important therapy for various neurologic diseases. Different interpretations of clinical trial results; the expected benefit of IVIg compared with that of alternate therapies; and issues about IVIg's safety, cost, and mechanisms of action have raised concern and uncertainty among practitioners. To clarify these areas, this paper examines the clinical, serologic, and immunologic data on more than 110 patients with various autoimmune neurologic diseases who received IVIg during the past 6 years at the National Institute of Neurological Disorders and Stroke. It also reviews work by other investigators on the efficacy, risks, benefits, and mechanisms of the action of IVIg in these diseases.

In controlled clinical trials, IVIg has been effective in treating the Guillain-Barre syndrome, multifocal motor neuropathy, chronic inflammatory demyelinating polyneuropathy, and dermatomyositis. In other controlled or open-label trials and case reports, IVIg produced improvement in several patients with the Lambert-Eaton myasthenic syndrome and myasthenia gravis but had a variable, mild, or unsubstantiated benefit in some patients with inclusion-body myositis, paraproteinemic IgM demyelinating polyneuropathy, certain intractable childhood epilepsies, polymyositis, multiple sclerosis, optic neuritis, and the stiff-man syndrome. The primary adverse reaction was headache; aseptic meningitis, skin reactions, thromboembolic events, and renal tubular necrosis occurred rarely. The most relevant immunomodulatory actions of IVIg, operating alone or in combination, are inhibition of complement deposition, neutralization of cytokines, modulation of Fc-receptor-mediated phagocytosis, and down-regulation of autoantibody production. Therapy with IVIg is effective for certain autoimmune neurologic diseases, but its spectrum of efficacy has not been fully established. Additional controlled clinical trials are needed.

http://www.annals.org/content/126/9/721.full

Conditions/disorders where IVIG treatment has shown promising results: Kawasaki syndrome(1), Guillain-Barre syndrome(1), Dermatomyositis(2), PANDAS(3), PITAND(3), Opsoclonus-Myoclonus(3) (without Neuroblastoma), neurologic sequel of a viral encephalitis(3) (particularly Herpes simplex virus, and enteroviruses, particularly Enterovirus 71), post-infectious encephalitis(3) (acute disseminated encephalitis - ADEM; can follow certain viral infections and/or the administration of certain viral vaccines), intractable (refractory) seizures(4) and in certain carefully chosen cases of Autism(5) and Anorexia Nervosa(5).

http://www.webpediatrics.com/ivig.html

Abstract Eight children aged between 1.3 and 13 years suffering from epilepsy refractory to conventional anticonvulsive therapy were treated with high dose intravenous gamma globulin (200 mg/kg, 3 times per week, repeated after 3 weeks). Immunological studies after therapy showed normal results. In four children, clinical and EEG findings markedly improved. In one other case a partial response was noted. No improvement was observed in the remaining three cases. We confirm that although the mechanism is still obscure, high doses of i.v. gammaglobulin may have a beneficial effect in a significant number of children with intractable epilepsy.

http://www.springerlink.com/content/lwrj66kj3j1l8313/


http://www.bcbst.com/mpmanual/!SSL!/...IG_Therapy.htm