Background IGIV therapy in rheumatology has been used as an alternative treatment for patients with refractory, severe disease, or with contraindication to the use of conventional immunosuppressive therapy as serious infections; it has recently been increased its use to treat multiple autoimmune diseases, however with a limited number of precise indications as there are not enough studies to increase the level of evidence for the administration of IVIG
Objectives To describe the experience gained with the use of IVIG in autoimmune rheumatic diseases in a third level medical center
Methods This is an observational, descriptive and retrospective study. We report the use of IVIG in our clinical practice, efficacy and adverse effects. We included consecutive patients with autoimmune rheumatic diseases that received IVIG between 2012 and 2015. The information was extracted from clinical records
Results We included 35 patients: 19 women, 16 men, 18 with systemic lupus erythematosus (SLE), 15 with autoimmune inflammatory myopathy, 1 with primary Sjögren's syndrome (SSp) and 1 with polyarteritis nodosa (PAN).
The most common indication was active disease associated with severe infection that contraindicated the use of immunosuppressants in 24 patients and in 11 patients refractory activity disease to conventional therapy. The most frequent indications in patients with SLE were: 6 thrombocytopenias, 5 lupus nephritis, 4 pulmonary hemorrhage and 3 neurolupus; of the group of inflammatory myopathy the indications were: 6 dysphagia, 5 respiratory insufficiency and 4 refractory myopathy. In patients with SSp and PAN the indication was peripheral neuropathy. The mean number of IVIG applications was 3.3 (range 1–15). Activity scales were decreased in all patients with IVIG: mean SLEDAI at baseline 15.6 and in the follow up 4.5; in inflammatory myopathies remission was reached in 86% of the cases.
The steroid dose was significantly reduced in most patients in the follow up. Four patients had adverse effects associated with IGIV: 2 with tachycardia and hypertension, one with acute pulmonary edema and one with hemolytic anemia.
Conclusions In our experience, IGIV administration was effective in controlling the activity of the autoimmune rheumatic disease, mainly in patients with concomitant infection, and with a good safety profile.
Discussion IGIV was an effective alternative treatment in patients with contraindication of conventional treatment or in refractory disease, however it is a high cost treatment and should be used in well selected cases
Erwin W. Gelfand, M.D. Intravenous Immune Globulin in Autoimmune and Inflammatory Diseases. N Engl J Med 2012;367:2015–25.
Bem Mulhearn I, and Ian N. Bruce. Indications for IVIG in rheumatic disease. Rheumatology 2015; 54: 383–391.
Disclosure of Interest None declared