SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

11/15/04

IV Ig therapy of autoimmune diseases

Summary
Background - In recent years, there has been a dramatic increase in the use of intravenous immunoglobulin (IV Ig) therapy in a variety of non-immunodeficiency conditions. Many of such trials of IV Ig treatment have been in proven or putative autoimmune disorders.

Findings - Shoenfeld and Krause of the Sheba Medical Center, Tel Hashomer, Israel described their experience treating a variety of autoimmune disorders with IV Ig. They pointed out that there is convincing evidence of the efficacy of IV Ig treatment in polymyositis from double- blind controlled trials. There is also impressive evidence of the efficacy in some patients with other autoimmune disorders. For example, a beneficial response to IV Ig (2G/Kg monthly) was observed in 17 of 20 SLE patients followed by their group, particularly those with low C4 levels or increased anti-Ro or anti-La Ab. Improvement in pregnancy outcomes were seen in the majority of women with anti-phospholipid antibodies and histories of recurrent spontaneous abortions. More recently, there has been an encouraging reduction of pulmonary fibrosis in scleroderma patients treated with IV Ig. There may even be slowing of metastatic malignancies during IV Ig therapy.

Reference
J Clin Immunol 2004;24:107-114

Editor's Comments
The extensive experience, albeit in uncontrolled studies, does suggest a beneficial effect of IV Ig in some patients with various autoimmune disorders. The authors feel that this evidence suggests that the beneficial effects in those disorders may often be associated with the presence in the pooled Ig preparations of anti-idiotypic antibodies directed against the possibly pathogenic auto- antibodies present in conditions such as SLE. However, other mechanisms may be involved. Further investigation, including controlled studies. will be required to obtain definitive conclusions about the efficacy of IV Ig in these conditions.

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