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Intravenous polyclonal human immunoglobulins in multiple sclerosis.

Abstract

Intravenous immunoglobulin (IVIG) is an established therapy for demyelinating diseases of the peripheral nervous system. IVIG exerts a number of effects that may be beneficial in multiple sclerosis (MS). Four double-blind IVIG trials have been performed in relapsing-remitting MS. A meta-analysis of the four trials has shown that IVIG reduces the relapse rate and, possibly, disease progression. In patients with a first episode of demyelinating disease, IVIG delays the time to the second relapse and thereby to the diagnosis of definite MS. In patients with an acute MS relapse, IVIG as add-on therapy to methylprednisolone does not make remission of symptoms faster or more complete. IVIG does not seem to be of any benefit to chronic visual or motor symptoms in MS. In secondary progressive MS, IVIG has not shown any effect on disease progression, relapses or new magnetic resonance imaging lesions. Experimental studies in the MS model experimental autoimmune encephalomyelitis in rats demonstrate that IVIG has to be administered at the time of induction of a relapse in order to be effective. In conclusion, IVIG can be considered as a second-line treatment to approved therapies for relapsing-remitting MS, but the ideal dosage of IVIG still needs to be determined. In order to be a first-line treatment for MS, the beneficial effect should be confirmed in a large-scale placebo-controlled survey, or in a study comparing the effect with approved therapies for relapsing-remitting MS using appropriate clinical and magnetic resonance imaging outcome measures.

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  • Publisher Full Text
  • Authors+Show Affiliations

    Danish MS Research Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. pss@rh.dk

    Source

    MeSH

    Animals
    Antibodies
    Clinical Trials as Topic
    Disease Progression
    Encephalomyelitis, Autoimmune, Experimental
    Humans
    Immunoglobulins, Intravenous
    Multiple Sclerosis
    Secondary Prevention
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    18075269

    Citation

    Soelberg Sorensen, Per. "Intravenous Polyclonal Human Immunoglobulins in Multiple Sclerosis." Neuro-degenerative Diseases, vol. 5, no. 1, 2008, pp. 8-15.
    Soelberg Sorensen P. Intravenous polyclonal human immunoglobulins in multiple sclerosis. Neurodegener Dis. 2008;5(1):8-15.
    Soelberg Sorensen, P. (2008). Intravenous polyclonal human immunoglobulins in multiple sclerosis. Neuro-degenerative Diseases, 5(1), pp. 8-15.
    Soelberg Sorensen P. Intravenous Polyclonal Human Immunoglobulins in Multiple Sclerosis. Neurodegener Dis. 2008;5(1):8-15. PubMed PMID: 18075269.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Intravenous polyclonal human immunoglobulins in multiple sclerosis. A1 - Soelberg Sorensen,Per, PY - 2006/05/29/received PY - 2007/05/14/accepted PY - 2007/12/14/pubmed PY - 2008/3/25/medline PY - 2007/12/14/entrez SP - 8 EP - 15 JF - Neuro-degenerative diseases JO - Neurodegener Dis VL - 5 IS - 1 N2 - Intravenous immunoglobulin (IVIG) is an established therapy for demyelinating diseases of the peripheral nervous system. IVIG exerts a number of effects that may be beneficial in multiple sclerosis (MS). Four double-blind IVIG trials have been performed in relapsing-remitting MS. A meta-analysis of the four trials has shown that IVIG reduces the relapse rate and, possibly, disease progression. In patients with a first episode of demyelinating disease, IVIG delays the time to the second relapse and thereby to the diagnosis of definite MS. In patients with an acute MS relapse, IVIG as add-on therapy to methylprednisolone does not make remission of symptoms faster or more complete. IVIG does not seem to be of any benefit to chronic visual or motor symptoms in MS. In secondary progressive MS, IVIG has not shown any effect on disease progression, relapses or new magnetic resonance imaging lesions. Experimental studies in the MS model experimental autoimmune encephalomyelitis in rats demonstrate that IVIG has to be administered at the time of induction of a relapse in order to be effective. In conclusion, IVIG can be considered as a second-line treatment to approved therapies for relapsing-remitting MS, but the ideal dosage of IVIG still needs to be determined. In order to be a first-line treatment for MS, the beneficial effect should be confirmed in a large-scale placebo-controlled survey, or in a study comparing the effect with approved therapies for relapsing-remitting MS using appropriate clinical and magnetic resonance imaging outcome measures. SN - 1660-2854 UR - https://www.unboundmedicine.com/medline/citation/18075269/full_citation L2 - https://www.karger.com?DOI=10.1159/000109932 DB - PRIME DP - Unbound Medicine ER -