RESEARCH - High dose IVIg in severe refractory RA: no evidence for efficacy

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Clin Exp Rheumatol. 1996 Nov-Dec;14(6):657-60.

High dose intravenous immunoglobulin (IVIg) in severe refractory

rheumatoid arthritis: no evidence for efficacy.

Maksymowych WP, Avina-Zubieta A, Luong M, AS.

School of Medicine, University of Alberta, Edmonton, Canada.

OBJECTIVE: A number of reports have recently suggested that high doses

of intravenous immunoglobulins may exert beneficial effects in

rheumatoid arthritis. One proposed mechanism for this effect is

suppression of the generation of pro-inflammatory cytokines,

particularly tumor necrosis factor alpha (TNF alpha). We have undertaken

a prospective open study of IVIg in patients with severe refractory RA

who have failed at least four second line drugs, including methotrexate,

and who were receiving NSAIDs and prednisone only. METHODS: Four

patients, 3 males and 1 female, with an average age of 58.25 years

(range 41-69 years) and a mean disease duration of 13 years (range 9-14

years), were given IVIg at a dose of 1 g per day for 2 days once a month

for 3 months. All patients had active disease at baseline as indicated

by an average tender joint count of 15 and an average swollen joint

count of 15.25. Clinical assessments were performed according to the

WHO/ILAR recommendations at baseline and at monthly intervals up to 4

months after the initiation of IVIg therapy. Patients were classified as

responders or non-responders according to the us criteria.

Laboratory assessment included a CBC, ESR, and whole blood cytokine

ELISA for TNF alpha, TNF R1, and TNF R2 at baseline, 1 day, 7 days and 3

months after the initiation of therapy. RESULTS: None of the patients

met the us criteria for either improvement or worsening.

Furthermore, increased TNF alpha production in lipopolysaccharide (LPS)

stimulated whole blood assays was consistently noted in 3 out of the 4

patients during the course of therapy which, together with the lack of

clinical efficacy, prompted us to curtail further evaluation of this

therapy.

CONCLUSION: We were unable to discern any beneficial effects of IVIg

therapy, and suggestions that it may enhance TNF alpha generation as

well as its substantial cost mandate caution in the future use of this

agent in RA.

PMID: 8978962

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

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