Clinical Efficacy of Intravenous Immunoglobulin for Patients with MPO-ANCA-Associated Rapidly Progressive Glomerulonephritis

Abstract

Background: To determinewhether intravenous immunoglobulin (IVIg) cancontrol disease activity in patients with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated rapidly progressive glomerulonephritis (RPGN). Methods: Twelve patients with serologically and histologically confirmed MPO-ANCA-associated RPGN (7 men, 5 women; mean age 71 ± 3 years) received IVIg (400 mg/kg/day) alone for 5 days. The effects of IVIg were evaluated by white blood cell counts, serum C-reactive protein levels, Birmingham Vasculitis Activity Score, rate of change in reciprocal creatinine (1/Cre), and plasma tumor necrosis factor-α levels after IVIg administration. Corticosteroids with or without cyclophosphamide were commenced after IVIg. Results:After IVIg treatment, a significant decrease was observed in white blood cell count (p < 0.05), C-reactive protein values (p < 0.001), and Birmingham Vasculitis Activity Score (p < 0.001) concomitant with the amelioration of systemic symptoms. The rate of change in 1/Cre significantly improved (p < 0.05). Plasma tumor necrosis factor-α levels that were significantly elevated in patients before IVIg compared with normal controls (p < 0.0001), rapidly declined after IVIg with a significant reduction(p < 0.05). Three months post-treatment with IVIg, all patients showed improvement of disease without serious infectious complications. Conclusion: IVIg is a potential component of remission induction therapy for patients with MPO-ANCA-associated RPGN.

Administration of human immunoglobulin suppresses development of murine systemic vasculitis induced with Candida albicans water-soluble fraction: an animal model of Kawasaki disease

“…In addition, in recent years intravenous administration of h-Ig has been tested in the treatment of other necrotizing vasculitic disorders [17][18][19]. The efficacy of h-Ig in the treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis has gained particular attention [20,21]. It is also known that the myeloperoxidase (MPO)-ANCA titer increases in some acute-stage KD patients [22].…”

Expression of Tumor Necrosis Factor Receptors on Granulocytes in Patients with Myeloperoxidase Anti-Neutrophil Cytoplasmic Autoantibody-Associated Vasculitis

“…This might be due to the effect of renal function on the sTNFR1 and sTNFR2 levels. In the literature, TNF-α, sTNFR1, and sTNFR2 in the serum of MPO-ANCA-associated vasculitis were reported to be higher than in the healthy controls [2, 3]. However, there have been no reports about the surface expression levels of TNFR1 and TNFR2 on the granulocytes in MPO-ANCA-associated vasculitis.…”

“…In vitro studies have indicated that tumor necrosis factor (TNF)-α and ANCA together induce the activation of neutrophils, and these activated neutrophils attach to the endothelium, release their toxic granule constituents and oxygen radicals, and thereby cause vascular damage [1]. The plasma TNF-α level in patients with ANCA-associated systemic vasculitis was reported to be increased [2, 3]. However, there are no reports on the expression levels of TNF receptor 1 (TNFR1) and TNF receptor 2 (TNFR2) on granulocytes.…”

Intravenous Immunoglobulin as an Immunomodulating Agent in Antineutrophil Cytoplasmic Antibody–Associated Vasculitides: A French Nationwide Study of Ninety‐Two Patients

“…The only 2 randomized trials reported in the literature in which the benefit of IVIG was investigated indicated a significant improvement in patients with GPA and with MPA (9,10). Another study of 12 patients with MPO-ANCA-associated rapidly progressive glomerulonephritis found clinical (50% reduction in the BVAS) and biologic (50% reduction in the CRP level) improvement after a 5-day course of IVIG alone, although there was no control arm (22). A recent series of 5 GPA patients treated with IVIG for opportunistic infections and/or active disease found an 80% remission rate at 9 months, but some of the patients were receiving other immunosuppressive agents in addition to IVIG (23).…”