Efficacy of intravenous gammaglobulin therapy in chronic refractory polymyositis and dermatomyositis: An open study with 20 adult patients

Chérìn, P.; Herson, S.; Wechsler, B.; Piette, Jean‐Charles; Blëtry, O.; Coutellier, A; Ziza, Jean-Marc; Godeau, P

doi:10.1016/0002-9343(91)90009-m

Cited by 256 publications

(135 citation statements)

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“…We used preparations of commercial, polyvalent human IVIG with an elevated proportion of intact plasma IgG. IVIG was administered slowly (Ͻ200 ml/hour) at 1 gm/kg body weight for 2 consecutive days per month, as described previously (9). The doses and immunosuppressive medication remained constant during the study period, as did routine daily activities.…”

Section: Methodsmentioning

confidence: 99%

“…The doses and immunosuppressive medication remained constant during the study period, as did routine daily activities. In the absence of clinical response, IVIG therapy was stopped after the third dose (8,9). The patients who were considered responders received at least 6 doses of IVIG.…”

Section: Methodsmentioning

confidence: 99%

“…To increase precision, each number was subdivided, resulting in a possible score of between 0 and 11, as previously described (9). The intensity of the muscular deficit was determined from the total quotation of 8 muscles: neck flexors, trapezius, deltoid, biceps, psoas, maximus and medius gluteus, and quadriceps.…”

Section: Methodsmentioning

confidence: 99%

“…All patients were tested by the same independent examiner, who is a specialist in neuromuscular diseases. As described in our previous studies (8,9,29), IVIG treatment was considered to be successful if the muscle power score increased by Ն18 points compared with the initial score.…”

Section: Methodsmentioning

confidence: 99%

“…High-dose intravenous immunoglobulin (IVIG) has been shown to be beneficial in a few open, prospective studies on adult and/or juvenile DM with short followup periods (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and in 1 controlled crossover study (23). In DM, IVIG prevents activated complement from damaging cutaneous and muscular lesions, inhibits C3 uptake in the sera, reduces serum levels of the SC5b-9 complex, depletes C3b NEO (a neoantigen that is expressed on the surface of activated C3 component upon incorporation into immune complexes) in muscles, prevents membrane attack complex deposits from entering the endomysial capillaries, and restores the capillary network (23)(24)(25).…”

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confidence: 99%

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Results and long‐term followup of intravenous immunoglobulin infusions in chronic, refractory polymyositis: An open study with thirty‐five adult patients

Chérìn

Pelletier

Teixeira

et al. 2002

Arthritis & Rheumatism

225

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Objective. Polymyositis is a rare inflammatory muscular disease of unknown cause. Corticosteroids and immunosuppressive drugs are the first choice of therapy but are not always effective and may cause serious side effects. Many studies have shown that polyvalent intravenous immunoglobulin (IVIG) may be of interest for the treatment of dermatomyositis. We carried out an open, prospective study to evaluate the efficacy of IVIG in subjects with polymyositis that was refractory to traditional treatments, and we evaluated the benefits of this therapy over a long-term period of followup.Methods. Thirty-five adult white patients (20 female, 15 male, mean age 43.5 years [SD 16.8]) with chronic, refractory polymyositis were treated with high doses of IVIG, after the patients had received the following traditional treatments: prednisone (n ‫؍‬ 35), methotrexate (n ‫؍‬ 24), azathioprine (n ‫؍‬ 13), cyclophosphamide (n ‫؍‬ 4), cyclosporine (n ‫؍‬ 7), chlorambucil (n ‫؍‬ 1), plasmapheresis (n ‫؍‬ 8), lymphopheresis (n ‫؍‬ 1), and total body irradiation (n ‫؍‬ 1). There had been no changes in the patients' treatment in the 2 months before the initiation of IVIG therapy, and doses were not increased during IVIG treatment. We used preparations of polyvalent human IVIG with increased concentrations of intact IgG. The patients received 1 gm/kg/day for 2 consecutive days per month. The mean course of treatment was 4-6 months. The clinical assessment involved the evaluation of proximal muscle power, muscle disability scale score, and esophageal disorders. The biochemical evaluations carried out before each treatment period were compared by Student's t-test and nonparametric Wilcoxon test. Results were considered to be significant at P ‫؍‬ 0.05.Results. In the short-term, significant clinical improvement was noted in 25 of the 35 patients (71.4%). Mean muscle power was estimated before and after IVIG therapy and was found to be significantly improved (P < 0.01). All patients had a significant biochemical response. Mean creatine kinase levels during IVIG therapy decreased significantly before the fourth IVIG perfusion (P < 0.01). Side effects, usually minor, were noted in 6 patients. This benefit allowed the initial prednisone dose to be reduced by >50% in all patients. The mean (؎SD) followup time for the 25 patients who responded favorably to IVIG treatment was 51.4 ؎ 13.1 months. Twelve of these 25 patients remained in full remission following their initial course of IVIG, resulting in complete stoppage of medication in 5 patients or low doses of steroids in 7 patients. The condition of 6 patients remained improved and no other drugs were prescribed, but the patients remained dependent on IVIG infusions. Seven of the 25 patients who responded well to IVIG treatment relapsed at an average of 17.1 months (range 4-23 months) after the discontinuation of IVIG. Conclusion. IVIG is an interesting therapy for the treatment of polymyositis, with results showing that the

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%