Intravenous Immunoglobulin in the Therapeutic Armamentarium of Systemic Lupus Erythematosus

Abstract

Prepared from the plasma of thousands of blood donors, therapeutic intravenous immunoglobulin (IVIg) mostly consists of human polyspecific immunoglobulin G (IgG). The use of IVIg in systemic lupus erythematosus (SLE) is still considered experimental without any clear indications.The purpose of this systematic review is, therefore, to evaluate the available evidence to determine the therapeutic role of IVIg in SLE.A comprehensive, computerised search was performed in the MEDLINE (Pubmed), Scopus, EMBASE, and Cochrane controlled trials.The study eligibility criteria were randomized controlled trials, and prospective and retrospective observational studies that examined the efficacy of IVIg in adult patients with SLE who were considered the participants.IVIg therapy was the mode of intervention in these patients.Data abstracted included the study design, study population, changes in the disease activity scores (Systemic Lupus Erythematosus Disease Activity Index, Systemic Lupus Activity Measure, and Lupus Activity Index-Pregnancy), steroid dose, complement levels, autoantibodies, and renal function. Thereafter, data analysis established statistical procedures for meta-analysis.Thirteen studies (including 3 controlled and 10 observational) were eligible for inclusion. There was significant reduction in the SLE disease activity scores with IVIg therapy with a standard mean difference of 0.584 (P = 0.002, 95% confidence interval [CI] 0.221–0.947). In terms of rise in complement levels, the response rate was 30.9% (P = 0.001, 95 CI 22.1–41.3). The effects of IVIg on other clinical outcome measures including anti-double-stranded DNA, antinuclear antibody, average steroid dose, and renal function could not be determined because of the limited numbers of trials.The limitations of this review were lack of well-designed controlled trials with adequate sample size on the use of IVIg in SLE.In conclusion, the use of IVIg is associated with significant reduction in SLE disease activity and improvement in complement levels.

2019 Update of the Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA–EDTA) recommendations for the management of lupus nephritis

“…The combination of RTX and belimumab has recently been used in refractory disease. 85 Highdose intravenous immunoglobulin (2 g/kg) could be considered when there are contraindications to increasing glucocorticoids or immunosuppressive drugs, such as infection, 86 while plasma exchange is rarely indicated.…”

Systemic Lupus Erythematosus (SLE) Therapy: The Old and the New

“…Despite being used since the 1980s, IVIG therapy is still considered to be experimental without any clear indications. A systematic review of observational studies highlighted the association of IVIG administration with significant improvement in disease activity scores and complement levels [53].…”

Relationship between Neutrophil-to-Lymphocyte Ratio and Systemic Lupus Erythematosus: A Meta-analysis

“…However, it holds great significance in identifying reliable, practical, and economical biomarkers to assist in diagnosing SLE and quantifying the disease activity of SLE patients. The immune system of SLE patients is abnormally activated by autoantigens, which results in immune complex deposition and complement system activation, followed by chronic inflammation (1,2,6,7,9). Furthermore, chronic inflammation stimulated by environmental and genetic factors is a common characteristic of autoimmune diseases including SLE (10,11).…”