Intravenous Immunoglobulin Therapy in Rheumatic Diseases

Overview

Journal Nat Rev Rheumatol

Specialty Rheumatology

Date 2011 May 11

PMID 21556030

Citations 48

Authors

Jagadeesh Bayry

Vir Singh Negi

Srini V Kaveri

Affiliations

Soon will be listed here.

Abstract

Prepared from the collective plasma of several thousand people, therapeutic intravenous immunoglobulin (IVIg) consists mostly of human polyspecific IgG. In addition to its use in primary and secondary immune deficiencies, IVIg is used in the treatment of several rheumatic conditions, including Kawasaki disease, dermatomyositis and antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis. In these diseases, IVIg therapy generally involves the use of 2 g/kg administered over either 2 or 5 consecutive days. However, dosage regimens have not been thoroughly explored, and indications for IVIg in most rheumatic diseases, such as systemic lupus erythematosus, polymyositis and catastrophic antiphospholipid syndrome, derive from its off-label usage. Randomized clinical trials are warranted to support the evidence-based use of IVIg, and to identify the ideal administration protocols to maximize the benefits of what is a limited resource. Further research to improve the therapeutic application of IVIg relies essentially on the conception of next-generation immunoglobulin preparations and optimization of combined therapies with immunomodulatory drugs and biologic agents.

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References

Radosevich M, Burnouf T . Intravenous immunoglobulin G: trends in production methods, quality control and quality assurance. Vox Sang. 2009; 98(1):12-28. DOI: 10.1111/j.1423-0410.2009.01226.x. View

Branch D, Peaceman A, Druzin M, Silver R, El-Sayed Y, Silver R . A multicenter, placebo-controlled pilot study of intravenous immune globulin treatment of antiphospholipid syndrome during pregnancy. The Pregnancy Loss Study Group. Am J Obstet Gynecol. 2000; 182(1 Pt 1):122-7. DOI: 10.1016/s0002-9378(00)70500-x. View

Walter M, Lochmuller H, Toepfer M, Schlotter B, Reilich P, Schroder M . High-dose immunoglobulin therapy in sporadic inclusion body myositis: a double-blind, placebo-controlled study. J Neurol. 2000; 247(1):22-8. DOI: 10.1007/s004150050005. View

Ephrem A, Chamat S, Miquel C, Fisson S, Mouthon L, Caligiuri G . Expansion of CD4+CD25+ regulatory T cells by intravenous immunoglobulin: a critical factor in controlling experimental autoimmune encephalomyelitis. Blood. 2007; 111(2):715-22. DOI: 10.1182/blood-2007-03-079947. View

Chen M, Kallenberg C . ANCA-associated vasculitides--advances in pathogenesis and treatment. Nat Rev Rheumatol. 2010; 6(11):653-64. DOI: 10.1038/nrrheum.2010.158. View

Hsiao G, Wolf R, Kimpel D . Intravenous immunoglobulin to prevent recurrent thrombosis in the antiphospholipid syndrome. J Clin Rheumatol. 2006; 7(5):336-9. DOI: 10.1097/00124743-200110000-00017. View

Desai S, Chouksey A, Poll J, Berger M . A pilot study of equal doses of 10% IGIV given intravenously or subcutaneously. J Allergy Clin Immunol. 2009; 124(4):854-6. DOI: 10.1016/j.jaci.2009.07.051. View

Orange J, Hossny E, Weiler C, Ballow M, Berger M, Bonilla F . Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol. 2006; 117(4 Suppl):S525-53. DOI: 10.1016/j.jaci.2006.01.015. View

Toubi E, Kessel A, Shoenfeld Y . High-dose intravenous immunoglobulins: an option in the treatment of systemic lupus erythematosus. Hum Immunol. 2005; 66(4):395-402. DOI: 10.1016/j.humimm.2005.01.022. View

10.

Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y . Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation. 1996; 94(6):1379-85. DOI: 10.1161/01.cir.94.6.1379. View

11.

Blanchette V, Imbach P, Andrew M, Adams M, McMillan J, Wang E . Randomised trial of intravenous immunoglobulin G, intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura. Lancet. 1994; 344(8924):703-7. DOI: 10.1016/s0140-6736(94)92205-5. View

12.

Silverman E, Cawkwell G, Lovell D, Laxer R, Lehman T, Passo M . Intravenous immunoglobulin in the treatment of systemic juvenile rheumatoid arthritis: a randomized placebo controlled trial. Pediatric Rheumatology Collaborative Study Group. J Rheumatol. 1994; 21(12):2353-8. View

13.

Crispin J, Liossis S, Kis-Toth K, Lieberman L, Kyttaris V, Juang Y . Pathogenesis of human systemic lupus erythematosus: recent advances. Trends Mol Med. 2010; 16(2):47-57. PMC: 2823952. DOI: 10.1016/j.molmed.2009.12.005. View

14.

Grundtman C, Malmstrom V, Lundberg I . Immune mechanisms in the pathogenesis of idiopathic inflammatory myopathies. Arthritis Res Ther. 2007; 9(2):208. PMC: 1906803. DOI: 10.1186/ar2139. View

15.

Elovaara I, Apostolski S, van Doorn P, Gilhus N, Hietaharju A, Honkaniemi J . EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases: EFNS task force on the use of intravenous immunoglobulin in treatment of neurological diseases. Eur J Neurol. 2008; 15(9):893-908. DOI: 10.1111/j.1468-1331.2008.02246.x. View

16.

Vora S, Asherson R, Erkan D . Catastrophic antiphospholipid syndrome. J Intensive Care Med. 2006; 21(3):144-59. DOI: 10.1177/0885066606287041. View

17.

Nikolova K, Tchorbanov A, Djoumerska-Alexieva I, Nikolova M, Vassilev T . Intravenous immunoglobulin up-regulates the expression of the inhibitory FcgammaIIB receptor on B cells. Immunol Cell Biol. 2009; 87(7):529-33. DOI: 10.1038/icb.2009.36. View

18.

Dalakas M, Sonies B, Dambrosia J, Sekul E, Cupler E, Sivakumar K . Treatment of inclusion-body myositis with IVIg: a double-blind, placebo-controlled study. Neurology. 1997; 48(3):712-6. DOI: 10.1212/wnl.48.3.712. View

19.

Sher G, Matzner W, Feinman M, Maassarani G, Zouves C, Chong P . The selective use of heparin/aspirin therapy, alone or in combination with intravenous immunoglobulin G, in the management of antiphospholipid antibody-positive women undergoing in vitro fertilization. Am J Reprod Immunol. 1998; 40(2):74-82. DOI: 10.1111/j.1600-0897.1998.tb00394.x. View

20.

Ballow M . The IgG molecule as a biological immune response modifier: mechanisms of action of intravenous immune serum globulin in autoimmune and inflammatory disorders. J Allergy Clin Immunol. 2010; 127(2):315-23. DOI: 10.1016/j.jaci.2010.10.030. View