Cycles Of Intravenous Immunoglobulin Research Articles

The role of IVIg treatment in severe pemphigus vulgaris

High-dose intravenous immunoglobulin (IVIg) has become a part of the treatment armentarium in pemphigus vulgaris (PV). Some consider IVIg as an adjuvant steroid sparing agent in PV, while others as disease modifying that can be used as monotherapy. We report our experience with a series of 12 PV patients with severe disease treated with IVIg as an adjuvant therapy. Ten of 12 patients (83%) showed response to six cycles of IVIg, six (50%) having complete remission and four (33%) having a partial response. This response rate is concordant with previous reports. The therapy was well tolerated. In all 12 patients, treatment with IVIg allowed a gradual reduction of prednisone dose compared with baseline levels. IVIg treatment was beneficial as a steroid sparing agent in our series of patients with severe PV.

Response of Vasculitic Peripheral Neuropathy to Intravenous Immunoglobulin

Peripheral neuropathy is a prominent feature of the systemic and secondary vasculitides. Usually, it responds to corticosteroids therapy, but in certain cases it may resist corticosteroid or immunosuppressive treatment, or both. The objective of this study is to present case reports of patients who exhibited various inflammatory diseases, accompanied with vasculitic peripheral neuropathies, for which intravenous immunoglobulin (IVIg) was used for treatment. The study included 10 patients with the following: Sjögren's syndrome (1), systemic lupus erythematosus (2), vaccination-induced vasculitis (1), Churg-Strauss vasculitis (1), mixed cryoglobulinemia (2), polyarteritis nodosa (1), sarcoidosis (1), and scleroderma (1). All developed vasculitic peripheral neuropathy and were treated with 1-13 cycles of high-dose IVIg (2 g/kg body weight). The patients were followed up for 1-5 years after this treatment. Results showed that in all but two patients (mixed cryoglobulinemia associated with hepatitis C and sarcoidosis), neuropathy improved or completely resolved after IVIg treatment. In conclusion, IVIg may be beneficial in cases of resistant vasculitic peripheral neuropathy. IVIg should probably be considered as a sole or adjuvant treatment in patients for whom conventional treatment is contraindicated, or for patients in whom conventional treatment has failed.

Intravenous immunoglobulin treatment of four patients with juvenile polyarticular arthritis associated with persistent parvovirus B19 infection and antiphospholipid antibodies

Children with rheumatic oligoarthritis and polyarthritis frequently establish persistent parvovirus B19 infections that may be associated with the production of antiphospholipid antibodies (anti-PL IgG). In this study we analysed the influence of high-dose intravenous immunoglobulin (IVIG) therapy on virus load, on the level of anti-PL IgG and its potential capacity to improve the patients' clinical status. Four juvenile patients with long-lasting polyarticular rheumatic diseases and persistent parvovirus B19 infection, associated in three cases with the presence of antibodies against β2-glycoprotein I (anti-β2GPI IgG), were treated with two cycles of IVIG on five successive days (0.4 g/kg per day). Clinical parameters including scores of disease activity, virus load and anti-PL IgG levels were determined before, during and after treatment. Two patients showed a complete remission that has lasted 15 months. During that period they showed neither clinical nor laboratory signs of inflammation. Viral DNA was not detectable in serum, and a decrease in anti-β2GPI IgG was observed. As assessed by the Childhood Health Assessment Questionnaire and the Health-related Quality of Life Questionnaire for Children, both patients were no longer restricted in their activities of daily living and no impact on the health-related quality of life was observed. In one patient the therapy failed: there was no improvement of symptoms and no decrease in virus load or inflammatory parameters. In the fourth patient, clinical and laboratory parameters did not improve despite a decrease in both viral load and anti-PL IgG. Our results show that the use of IVIG to treat parvovirus B19-triggered polyarticular rheumatic disease of childhood might offer an opportunity to improve this disabling condition.

Clinical experience with IVIg Rx in patients with prior failed IVF pregnancies: report of 30 consecutive patients.

This study reviews one practitioner's experience with intravenous immunoglobulin (IVIg) therapy in the in-vitro fertilization (IVF) cycles of 30 patients with previous IVF failures. Thirty patients had undergone 82 prior assisted reproductive technology (ART) cycles (mean 3.9 +/- 2 failed ART cycles, median 3.0, range 1-8) yielding one term birth, one loss at 22.5 weeks, and five chemical pregnancies. These patients underwent comprehensive clinical and laboratory evaluation, including immunologic workup, and were accepted for IVIg therapy in their next IVF cycle. A total of 40 cycles were treated. Twenty-four (60%) of the IVIg-treated IVF cycles showed a positive human chorionic gonadotropin test. Comparing the IVIg cycles to the untreated ART cycles, there were no differences in the number of embryos transferred, fertilized embryos, or eggs. Eighty-six percent of the cases with confirmed implantation delivered; there was one chemical pregnancy, one 20-week spontaneous fetal death, and one trisomy. Five (24%) of the 21 pregnant patients delivered at 30-36 weeks. The remaining 13 delivered at term. Only three (11%) had no positive immune test. In what may be a selected population of IVF patients (with high incidence of abnormal immune testing), early IVIg therapy may be associated with the improved success of IVF, and the high rate of live birth.

Treatment of dermatomyositis with intravenous immunoglobulin

A patient affected by dermatomyositis, who did not respond to conventional therapies (steroids alone and in association with immunosuppressive drugs), developed necrotic lesions in the axillary and antecubital folds. The lesions did not improve after increasing the steroid dose. Treatment with intravenous immunoglobulin (IVIG) at a dose of 1 g/kg daily for 2 successive days every 4 weeks was started. Ten days after the first infusion of IVIG the cutaneous lesions disappeared and in the following months the muscle symptoms improved as well. The patient was treated with ten cycles of IVIG and then at a maintenance dose of 1 g/kg over one day every third month. This treatment has been demonstrated to be effective, but it is necessary to underline the need for an accurate selection of patients. The cost of nine months of therapy for a patient of 55 kg in body weight is about ±41 350 (L. 100 000 000).