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Intravenous immunoglobulin (IVIG) for the therapy of autoimmune disorders

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Abstract

The weight of evidence from numerous clinical studies supports the use of IVIG, particularly at higher doses, in the treatment of a wide range of autoimmune disorders. Extensive experience has documented the safety of IVIG therapy but its present relatively high cost necessitates firmly establishing its efficacy. There is an acute need to define those disease states where IVIG is indicated and effective. Large-scale, possibly multicentered, clinical trials employing rigorous controls will resolve these questions. Concurrent fundamental immunologic studies will elucidate the mechanisms underlying the clinical effects. We are experiencing an exciting new era of effective immunotherapies and intravenous gamma-globulin preparations have already secured an important place in the therapeutic armamentarium. While one must guard against unsubstantiated applications, critical exploration of new uses for this unique product is warranted.

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References

  1. Gupta S: Current and future uses of intravenous gamma globulin in autoimmune disorders. Immunol Allergy Pract 3:370–377, 1986

    Google Scholar 

  2. Imbach P, d'Apuzzo V, Hirt A, Rossi E, Vest M, Barundun S, Baumgartner C, Morell A, Schoni M, Wagner HP: High dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood. Lancet 1:1228–1230, 1981

    Google Scholar 

  3. Imbach P, Barandun S, Baumgartner C, Hirt A, Hofer F, Wagner HP: High dose intravenous gammaglobulin therapy of refractory, in particular idiopathic thrombocytopenia in childhood. Helv Paediat Acta 36:81–86, 1981

    Google Scholar 

  4. Lum LG, Tubergen DG, Corash L, Blaese RM: Splenectomy in the management of the thrombocytopenia of the Wiskott-Aldrich syndrome. N Engl J Med 302:892–896, 1980

    Google Scholar 

  5. Bussel JB: Intravenous immunoglobulin therapy for the treatment of idiopathic thrombocytopenia purpura. Prog Hemost Thromb 8:103–158, 1986

    Google Scholar 

  6. Lusher JM, Warrier I: Use of intravenous gamma globulin in children and adolescents with idiopathic thrombocytopenic purpura and other immune thrombocytopenias. Am J Med 83 (Suppl 4A):10–16, 1987

    Google Scholar 

  7. Becton DL, Kinney TR, Chaffee S, Kartzberg J, Friedman, HS, Falletta JM: High-dose intravenous immunoglobulin for severe platelet alloimmunization. Pediatrics 74:1120–1122, 1984

    Google Scholar 

  8. Junghans RP, Ahn YS: High-dose intravenous gamma globulin to suppress alloimmune destruction of donor platelets. Am J Med 76 (Suppl 3A):204–208, 1984

    Google Scholar 

  9. Schiffer CA, Hogge DE, Aisner J, Dutcher JP, Lee EJ, Papenberg D: High dose intravenous gammaglobulin in alloimmunized platelet transfusion recipients. Blood 64:937–940, 1984

    Google Scholar 

  10. Knupp C, Chamberlain JK, Raab SO: High-dose intravenous gamma globulin in autoimmunized platelet transfusion recipients. Blood 64:937, 1984

    Google Scholar 

  11. Kurtzberg J, Friedman HS, Kinney TR, Chaffee S, Falletta JM: Treatment of platelet alloimmunization with intravenous immunoglobulin. Two case reports and review of the literature. Am J Med 83 (Suppl 4A):30–33, 1987

    Google Scholar 

  12. Becker T, Panzer S, Maas D, Kiefel V, Sprenger R, Kirschbaum M, Mueller-Eckhardt C: High dose intravenous immunoglobulin for post-transfusion purpura. Br J Hematol 61:149–155, 1985

    Google Scholar 

  13. Berney SI, Metcalfe P, Wathen NC, Waters AN: Post transfusion purpura responding to high dose intravenous IgG: Further observations on pathogenesis. Br J Haematol 61:627, 1985

    Google Scholar 

  14. Sidiropoulos D, Straume B: The treatment of neonatal isoimmune thrombocytopenia of childhood with intravenous immunoglobulin (IgGIV). Blut 48:383, 1984

    Google Scholar 

  15. Castaman G, Rodeghiero F, Ronioni GF, Dini E: Successful treatment of neonatal “autoimmune” thrombocytopenia with high-dose intravenous immunoglobulins. Hematologica (Pavia) 70:276–277, 1985 (letter)

    Google Scholar 

  16. Ekert H: Intravenous immunoglobulin versus oral corticosteroids in acute immune thrombocytopenic purpura in childhood. Lancet 2:1310, 1985 (letter)

    Google Scholar 

  17. Hegde UM: Immune thrombocytopenia in pregnancy and the newborn: A review. J Infect 15 (Suppl 1):55–58, 1987

    Google Scholar 

  18. Morgenstern GR, Measday, B, Hegde UM: Autoimmune thrombocytopenia in pregnancy: New approach to management. Br Med J 287:584, 1983

    Google Scholar 

  19. Nilsson IM, Sundquist SB, Ljang R, Holmberg L, Freiburghaus C, Bjorlin G: Suppression of secondary antibody response by intravenous immunoglobulin in a patient with hemophilia B and antibodies. Scand J Haematol 30:458–464, 1983

    Google Scholar 

  20. Seifried E, Gaedicke G, Pindus G, Rasche H: The treatment of hemophilia A with high dose intravenous immunoglobulin. Blut 48:397–401, 1984

    Google Scholar 

  21. Gianella-Borradori A, Hirt A, Luthy A, Wagner HP, Imbach P: Haemophilia due to factor VIII inhibitors in a patient suffering from an autoimmune disease: Treatment with intravenous immunoglobulin. Blut 48:403–407, 1984

    Google Scholar 

  22. Zimmerman R, Kommarell B, Harenburg J, Eich W, Rother K, Schimpf KL: Intravenous IgG for patients with spontaneous inhibitor to factor VIII. Lancet 1:273–274, 1985

    Google Scholar 

  23. Sultan Y, Kazatchkine MD, Maisomeune P, Nydegger UE: Anti-idiotypic suppression of autoantibodies to factor VIII (antihaemophilic factor) by high-dose intravenous gammaglobulin. Lancet 2:765–768, 1984

    Google Scholar 

  24. Fehr J, Hoffman V, Kappeler U: Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high-dose intravenous gamma globulin. N Engl J Med 306:1254–1258, 1982

    Google Scholar 

  25. Salama A, Mueller-Eckhardt C, Kieffel V: Effect of intravenous immunoglobulin in immune thrombocytopenia. Lancet 2:193–194, 1983

    Google Scholar 

  26. Oda H, Honda H, Sugita K, Nakamura A, Nakajima H: High-dose intravenous intact IgG infusion in refractory autoimmune hemolytic anemia (Evans syndrome). J Pediat 107:744–746, 1985

    Google Scholar 

  27. Macintyre EA, Linch DC, Macey MG, Newland AC: Successful response to intravenous immunoglobulin in autoimmune haemolytic anemia. Br J Haematol 60:387–388, 1985

    Google Scholar 

  28. Porecco M, Ventura A, Tamaro P, Longo F: High-dose IVIgG in autoimmune hemolytic anemia. J Pediat 109:726, 1986 (letter)

    Google Scholar 

  29. Bussel JB, Cunningham-Rundles C, Abraham C: Intravenous treatment of autoimmune hemolytic anemia with very high dose gammaglobulin. Vox Sang 51:264–269, 1986

    Google Scholar 

  30. Richmond GW, Ray I, Korenblitt A: Initial stabilization preceding enhanced hemolysis in autoimmune hemolytic anemia treatment with intravenous gammaglobulin. J Pediat 110:917–919, 1987

    Google Scholar 

  31. Sasaki H, Akutagawa H, Kuwakado K, Uemura M, Emi I: High-dose intravenous IgG therapy in a seven-week-old infant with chronic autoimmune hemolytic anemia. Am J Hematol 25:215–218, 1987

    Google Scholar 

  32. McGuire WA, Yang HH, Bruno E, Brandt J, Briddell R, Coates TD, Hoffman R: Treatment of antibody-mediated pure red-cell aplasia with high-dose intravenous gamma globulin. N Engl J Med 317:1004–1008, 1987

    Google Scholar 

  33. Barbui T, Bassan R, Viero P, Minetti B, Comotti B, Buelli M: Pure white cell aplasia treated by high dose intravenous immunoglobulin. Br J Haematol 58:554–555, 1984 (letter)

    Google Scholar 

  34. Pollack S, Cunningham-Rundles C, Smithwick EM, Barandun S, Good RA: High dose intravenous gammaglobulin in autoimmune neutropenia. N Engl J Med 307:252, 1982

    Google Scholar 

  35. Bussel J, Lalezari P, Hilgartner M, Partin J, Fikrig S, O'Malley J, Barandun S: Reversal of neutropenia with intravenous gammaglobulin in autoimmune neutropenia of infancy. Blood 62:398–400, 1983

    Google Scholar 

  36. Hilgartner MW, Bussel J: Use of intravenous gamma globulin for the treatment of autoimmune neutropenia of childhood and autoimmune hemolytic anemia. Am J Med 83 (Suppl 4A):25–29, 1987

    Google Scholar 

  37. Bussell J, Lalezari P, Fikrig S: Intravenous treatment with gammaglobulin of autoimmune neutropenia of infancy. J Pediat 112:298–301, 1988

    Google Scholar 

  38. Kurtzberg J, Friedman HS, Chaffee S, Falletta JM, Kinney TR, Kurlander R, Matthews TJ, Schwartz RS: Efficacy of intravenous gamma globulin in autoimmune-mediated pediatric blood dyserasias. Am J Med 83 (Suppl 4A):4–9, 1987

    Google Scholar 

  39. Ahern M, Harkness J, Maddison P, Forskitt S: High-dose immunoglobulin in Felty's syndrome. Ann Rheum Dis 42:476–477, 1983 (letter)

    Google Scholar 

  40. Breedveld FC, Brand A, VanAken WG: High dose intravenous gamma globulin for Felty's syndrome. J Rheumatol 12:700–702, 1985

    Google Scholar 

  41. Murakami H, Kikuchi M, Toyama K, Ikeda Y: A case of autoimmune neutropenia and thrombocytopenia: Effect of high-dose intravenous immunoglobulin. Keio J Med 34:227–232, 1985

    Google Scholar 

  42. Ricevuti G, Mazzone A, Rizzo SC: A study of neutrophil function in a case of associated autoimmune neutropenia and thrombocytopenia treated with high doses of intravenous gammaglobulin (HDIGG). Clin Lab Haematol 8:325–335, 1986

    Google Scholar 

  43. Gajdos PH, Outin H, Elkhanat D: High dose intravenous gammaglobulin for myasthenia gravis. Lancet 1:406–407, 1984 (letter)

    Google Scholar 

  44. Fateh-Maghadam A, Besinger U, Geursen RG: High dose intravenous gamma globulin for myastenia gravis. Lancet 1:848–849, 1984 (letter)

    Google Scholar 

  45. Arsura EL, Bick A, Brunner NG, Namba T, Grob D: Highdose intravenous immunoglobulin in the management of myasthenia gravis. Arch Intern Med 146:1365–1368, 1986

    Google Scholar 

  46. Devathasan G, Kuch YK, Chong PN: High-dose intravenous gammaglobulin for myasthenia gravis. Lancet 2:809–810, 1984

    Google Scholar 

  47. Ippoliti G, Cosi V, Piccolo G, Lombardi M, Mantegaz R: High-dose intravenous gammaglobulin for myasthenia gravis. Lancet 2:809, 1984

    Google Scholar 

  48. Arsura E, Bick A, Brunner NG, Grob D: Effects of repeated doses of intravenous immunoglobulin in myasthenia gravis. Am J Med Sci 295:438–443, 1988

    Google Scholar 

  49. Cook L, Howard JF Jr, Folds JD: Immediate effects of intravenous IgG administration on peripheral blood B and T cells and polymorphonuclear cells in patients with myasthenia gravis. J Clin Immunol 8:23–31, 1988

    Google Scholar 

  50. Walker AE: Allergic phenomena as basic mechanisms in epilepsy.In Basic Mechanisms of the Epilepsies, HH Jasper, AA Ward, A Pope (eds), London, Churchill, 1969, p 812

    Google Scholar 

  51. Pechadre JC, DeVillepin A, Sauvezi B, Gibert J: Gammaglobulines et epilepsie. Rev Med 34:1889–1901, 1978

    Google Scholar 

  52. Laffont F, Esnault S, Gilbert A, Peytour MA, Cathola HP, Eygonnet JP: Effets des gammaglobulines sur des epilepsies rebelles. Etude preliminaire. Ann Med Interne (Paris) 130:307–312, 1979

    Google Scholar 

  53. Ariizumi M, Shiihara H, Hibio S, Ryo S, Baba K, Ogawa K, Suzuki Y, Momoki T: High dose gamma globulin for intractable childhood epilepsy. Lancet 2:162–163, 1983

    Google Scholar 

  54. Sandstedt P, Kostulas V, Larsson LE: Intravenous gammaglobulin for post-encephalitic epilepsy. Lancet 2:1154–1155, 1984

    Google Scholar 

  55. Bedini R, de Feo MR, Orano A, Rocchi L: Effects of gamma globulin therapy in severely epileptic children. Epilepsia 26:98–102, 1985

    Google Scholar 

  56. Schwartz SA, Gordon KE, Johnston MN, Goldstein GW: Use of intravenous immune globulin in the treatment of seizure disorders. J Allergy Clin Immunol 84:603–607, 1989

    Google Scholar 

  57. Duse M, Tibert S, Plebani M, Avanzini MA, Gardenghi M, Menegati E, Morrafo V, Ugazio AG: IgG2 deficiency and intractable epilepsy of childhood. Monogr Allergy 20:128–134, 1986

    Google Scholar 

  58. Erlendsson K, Swartz T, Dwyer JM: Successful reversal of echovirus encephalitis in X-linked hypogammaglobulinemia by intraventricular administration of immunoglobulin. N Engl J Med 312:351–353, 1985

    Google Scholar 

  59. Schuller E, Govaerts A: First results of immunotherapy with immunoglobulin G in multiple sclerosis patients. Eur Neurol 22:205–212, 1983

    Google Scholar 

  60. Rothfelder U, Neu I, Pelka R: Therapie der multiplen sklerose mit immunglobulin G. Munch Med Wochenschr 124(4):74–78, 1982

    Google Scholar 

  61. Soukop W, Tschabitscher H: Gammaglobulintherapie bei multipler sklerose (MS). Theoretische uberlegungen und erste klinische erfahrungen mit 7S-immunoglobulin in der MS-therapie. Wien Med Wochenschr 136:477–480, 1986

    Google Scholar 

  62. Vermeulen M, van der Meche FGA, Speelman JD, Weber A, Busch HFM: Plasma and gamma-globulin infusion in chronic inflammatory polyneuropathy. J Neurol Sci 70:317–326, 1985

    Google Scholar 

  63. Gaedicke G, Teller WM, Kahne E, Dopfer R, Niethammer D: IgG therapy in systemic lupus erythematosus—two case reports. Blut 48:387–390, 1984

    Google Scholar 

  64. Lin RY, Racis SP: In vivo reduction of circulating C1q binding immune complexes by intravenous gammaglobulin administration. Int Arch Allergy Appl Immunol 79:286–290, 1986.

    Google Scholar 

  65. Hanada T, Saito K, Nagasawa T, Kabashima T, Nakahara S, Okuyama A, Takita H: Intravenous gammaglobulin therapy for thromboneutropenic neonates of mothers with systemic lupus erythematosus. Eur J Haematol 38:400–404, 1987

    Google Scholar 

  66. Ballow M, Parke A: The uses of intravenous immune globulin in collagen vascular disorders. J Allergy Clin Immunol 84:608–612, 1989

    Google Scholar 

  67. Gelfand EW: The use of intravenous immune globulin in collagen vascular disorders: A potentially new modality of therapy. J Allergy Clin Immunol 84:613–616, 1989

    Google Scholar 

  68. Sany J, Clot J, Bonneau M, Andacy M: Immunomodulating effect of human placenta eluted gamma globulins in rheumatoid arthritis. Arth Rheum 25:17–24, 1982

    Google Scholar 

  69. Combe B, Corso B, Clot J, Bonneau M, Sany J: Human placenta-eluted gamma globulins in immunomodulating treatment of rheumatoid arthritis. Am J Med 78:920–928, 1985

    Google Scholar 

  70. Morens DM, Anderson LJ, Hurwitz ES: National surveillance of Kawasaki disease. Pediatrics 65:21–25, 1980

    Google Scholar 

  71. Furosho K, Kamiga T, Nakana H, Kiyosawa N, Shinomiya K, Hayashidera T, Tomara T, Hirose O, Manabe Y, Yokoyama T, Kawarano M, Baba K, Baba K, Mori C: High dose intravenous gamma globulin for Kawasaki disease. Lancet 2:1055–1058, 1984

    Google Scholar 

  72. Newburgh JW, Takahashi M, Burns JC, Beiser AS, Chung KJ, Duffy CE, Glode MP, Mason WH, Reddy V, Sanders SP, Shulman ST, Wiggins JW, Hicks RV, Fulton DR, Lewis AB, Leung DYM, Colton T, Rosen FS, Melish ME: The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 315:341–347, 1986

    Google Scholar 

  73. Committee on Infectious Diseases: Intravenous gamma globulin use in children with Kawasaki disease. Pediatrics 82:122, 1988

    Google Scholar 

  74. Mason W, Jordan S, Sakai R, Takahashi M: Lack of effect of gamma-globulin infusion on circulating immune complexes in patients with Kawasaki syndrome. Pediatric Infect Dis 7:94–99, 1988

    Google Scholar 

  75. Shulman ST (ed): Kawasaki disease (Proceedings of the Second Internation Kawasaki Disease Symposium) New York, Alan R. Liss, 1987

    Google Scholar 

  76. Rowley AH, Shulman ST: What is the status of intravenous gamma globulin for Kawasaki syndrome? Pediat Infect Dis J 7:463–466, 1988

    Google Scholar 

  77. Geutren G, Papor L, Assan R, Vialattes B, Vexiau P: Cyclosporin increases the rate and length of remission in insulin-dependent diabetes of recent onset. Lancet 2:119–124, 1986

    Google Scholar 

  78. Heinze E, Thon A, Vetter U, Gaedicke G, Zuppinger K: Gamma-globulin therapy in 6 newly diagnosed diabetic children. Acta Paediat Scand 74:605–606, 1985

    Google Scholar 

  79. Pocecco M, DeCampo C, Cantoni L, Tedesco F, Fanizon: Effect of high doses intravenous IgG in newly diagnosed diabetic children. Helv Paediat Acta 42:289–295, 1987

    Google Scholar 

  80. Godard W, Roujeau JC, Guillot B, Andre C, Rifle G: Bullous pemphigoid and intravenous gammaglobulin. Ann Intern Med 103–965, 1985 (letter)

  81. Jerne NK: The immune system: A web of V-domains.Harvey lectures, Series 70. New York, Academic Press, 1976

    Google Scholar 

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Schwartz, S.A. Intravenous immunoglobulin (IVIG) for the therapy of autoimmune disorders. J Clin Immunol 10, 81–89 (1990). https://doi.org/10.1007/BF00918189

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