Intravenous Immunoglobulin for Postpolio Syndrome: a Systematic Review and Meta-analysis

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2015 Apr 18

PMID 25886512

Citations 2

Authors

Yao-Hsien Huang

Hung-Chou Chen

Kuang-Wei Huang

Po-Chih Chen

Chaur-Jong Hu

Chin-Piao Tsai

Ka-Wai Tam

Yi-Chun Kuan

Affiliations

Soon will be listed here.

Abstract

Background: Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial.

Methods: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels.

Results: We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = -1.02, 95% confidence interval [CI] = -2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI -0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity.

Conclusion: The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.

Citing Articles

Post-polio syndrome is not a dysimmune condition.

Laffont I, Duflos C, Hirtz C, Bakhti K, Gelis A, Palayer C Eur J Phys Rehabil Med. 2024; 60(2):270-279.

PMID: 38252127 PMC: 11112507. DOI: 10.23736/S1973-9087.23.08158-3.

Pain-resolving immune mechanisms in neuropathic pain.

Fiore N, Debs S, Hayes J, Duffy S, Moalem-Taylor G Nat Rev Neurol. 2023; 19(4):199-220.

PMID: 36859719 DOI: 10.1038/s41582-023-00777-3.

References

Gonzalez H, Khademi M, Borg K, Olsson T . Intravenous immunoglobulin treatment of the post-polio syndrome: sustained effects on quality of life variables and cytokine expression after one year follow up. J Neuroinflammation. 2012; 9:167. PMC: 3464723. DOI: 10.1186/1742-2094-9-167. View

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

Soderholm S, Lehtinen A, Valtonen K, Ylinen A . Dysphagia and dysphonia among persons with post-polio syndrome - a challenge in neurorehabilitation. Acta Neurol Scand. 2010; 122(5):343-9. DOI: 10.1111/j.1600-0404.2009.01315.x. View

Fordyce C, Gagne D, Jalili F, Alatab S, Arnold D, Da Costa D . Elevated serum inflammatory markers in post-poliomyelitis syndrome. J Neurol Sci. 2008; 271(1-2):80-6. DOI: 10.1016/j.jns.2008.03.015. View

Grimby G, Stalberg E, Sandberg A, Sunnerhagen K . An 8-year longitudinal study of muscle strength, muscle fiber size, and dynamic electromyogram in individuals with late polio. Muscle Nerve. 1998; 21(11):1428-37. DOI: 10.1002/(sici)1097-4598(199811)21:11<1428::aid-mus10>3.0.co;2-x. View

Gonzalez H, Khademi M, Andersson M, Piehl F, Wallstrom E, Borg K . Prior poliomyelitis-IVIg treatment reduces proinflammatory cytokine production. J Neuroimmunol. 2004; 150(1-2):139-44. DOI: 10.1016/j.jneuroim.2004.01.010. View

Gonzalez H, Olsson T, Borg K . Management of postpolio syndrome. Lancet Neurol. 2010; 9(6):634-42. DOI: 10.1016/S1474-4422(10)70095-8. View

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

Koopman F, Uegaki K, Gilhus N, Beelen A, de Visser M, Nollet F . Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2011; (2):CD007818. DOI: 10.1002/14651858.CD007818.pub2. View

10.

Andres P, Hedlund W, Finison L, Conlon T, Felmus M, Munsat T . Quantitative motor assessment in amyotrophic lateral sclerosis. Neurology. 1986; 36(7):937-41. DOI: 10.1212/wnl.36.7.937. View

11.

Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D . Development of a fatigue scale. J Psychosom Res. 1993; 37(2):147-53. DOI: 10.1016/0022-3999(93)90081-p. View

12.

Washburn R, McAuley E, Katula J, Mihalko S, Boileau R . The physical activity scale for the elderly (PASE): evidence for validity. J Clin Epidemiol. 1999; 52(7):643-51. DOI: 10.1016/s0895-4356(99)00049-9. View

13.

Gonzalez H, Sunnerhagen K, Sjoberg I, Kaponides G, Olsson T, Borg K . Intravenous immunoglobulin for post-polio syndrome: a randomised controlled trial. Lancet Neurol. 2006; 5(6):493-500. DOI: 10.1016/S1474-4422(06)70447-1. View

14.

Hozo S, Djulbegovic B, Hozo I . Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5:13. PMC: 1097734. DOI: 10.1186/1471-2288-5-13. View

15.

Carlsson A . Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983; 16(1):87-101. DOI: 10.1016/0304-3959(83)90088-X. View

16.

Farbu E, Rekand T, Vik-Mo E, Lygren H, Gilhus N, Aarli J . Post-polio syndrome patients treated with intravenous immunoglobulin: a double-blinded randomized controlled pilot study. Eur J Neurol. 2007; 14(1):60-5. DOI: 10.1111/j.1468-1331.2006.01552.x. View

17.

Ostlund G, Broman L, Werhagen L, Borg K . IVIG treatment in post-polio patients: evaluation of responders. J Neurol. 2012; 259(12):2571-8. DOI: 10.1007/s00415-012-6538-y. View

18.

Higgins J, Altman D, Gotzsche P, Juni P, Moher D, Oxman A . The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928. PMC: 3196245. DOI: 10.1136/bmj.d5928. View

19.

Bertolasi L, Frasson E, Turri M, Gajofatto A, Bordignon M, Zanolin E . A randomized controlled trial of IV immunoglobulin in patients with postpolio syndrome. J Neurol Sci. 2013; 330(1-2):94-9. DOI: 10.1016/j.jns.2013.04.016. View

20.

Jenkinson C . The SF-36 physical and mental health summary measures: an example of how to interpret scores. J Health Serv Res Policy. 1998; 3(2):92-6. DOI: 10.1177/135581969800300206. View