The steroid-sparing effect of intravenous immunoglobulin in patients with autoimmune diseases

Abstract

This review covers the major advances in the therapeutic potential of intravenous immunoglobulin (IVIg) as a steroid-sparing agent in autoimmune diseases utilizing a structured search of Medline (1992-2007). IVIg is a potent biological drug, utilized routinely for idiopathic thrombocytopenic purpura, Kawasaki's diseases, Guillain-Barre syndrome and dermatomyositis. In addition, however, IVIg is an adjunct second-line therapy in neuroimmunologic, infectious, dermatologic, hematologic, obstetric, autoimmune, inflammatory and idiopathic disorders. Compared with immunosuppressive agents administered routinely for systemic autoimmune diseases, IVIg is advantageous, owing to its few and transient minor adverse effects. Hence, it is logical to deliver IVIg with steroids as a sparing agent. All the published material on IVIg and its steroid-sparing effect was reviewed. Currently, there is insufficient evidence to confirm that IVIg has a significant steroid-sparing effect. Based on the available information, IVIg has the potential to act as a steroid-sparing agent in systemic lupus erythematosus and autoimmune blistering diseases, but its effect in other autoimmune diseases remains uncertain. Further investigation is warranted where this issue will be addressed as a primary endpoint and in controlled trials.

Biologic therapy for autoimmune diseases: an update

“…It is beneficial for the treatment of serositis, cardiopulmonary disease, hematological conditions, diffuse neuropsychiatric disease, and lupus nephritis [53-55]. In patients with SLE, IVIG has a steroid-sparing effect [56]. High-dose IVIG was beneficial for SLE, and led to a decrease in various scores of disease activity.…”

Intravenous immunoglobulin: a biological corticosteroid-sparing agent in some autoimmune conditions

“…One of the extensively studied mechanisms of IVIg is the down-regulation of anti-idiotypic antibodies interacting with B cells and neutralizing the pathogenic idiotypes. 20,21 IVIg may have a steroid-sparing effect. Goddard et al.…”

“…Goddard et al. 21 evaluated the clinical outcome and the steroid-sparing effect in 17 patients with autoimmune diseases; among them, 11 were patients with SLE. All patients were treated with high-dose IVIg (2 g/kg over a 5-dayperiod, once a month, for 6 months, followed by therapy every 2–3 months) and GCs.…”

The place of intravenous immunoglobulin in rheumatic diseases

“…Zandman-Goddard и соавт. [14] проанализировали клинические исхо-ды и стероид-сберегающий эффект ВВИГ у 17 пациентов с различными аутоиммунными заболеваниями. Все больные получали высокие дозы ВВИГ (2 г/кг в течение 5 дней в месяц курсом 6 мес с последующей терапией каждые 2-3 мес) и ГК.…”