EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases

Abstract

Despite high-dose intravenous immunoglobulin (IVIG) is widely used in treatment of a number of immune-mediated neurological diseases, the consensus on its optimal use is insufficient. To define the evidence-based optimal use of IVIG in neurology, the recent papers of high relevance were reviewed and consensus recommendations are given according to EFNS guidance regulations. The efficacy of IVIG has been proven in Guillain-Barre´syndrome (level A), chronic inflammatory demyelinating polyradiculoneuropathy (level A), multifocal mononeuropathy (level A), acute exacerbations of myasthenia gravis (MG) and short-term treatment of severe MG (level A recommendation), and some paraneoplastic neuropathies (level B). IVIG is recommended as a second-line treatment in combination with prednisone in dermatomyositis (level B) and treatment option in polymyositis (level C). IVIG should be considered as a second or third-line therapy in relapsing-remitting multiple sclerosis, if conventional immunomodulatory therapies are not tolerated (level B), and in relapses during pregnancy or post-partum period (good clinical practice point). IVIG seems to have a favourable effect also in paraneoplastic neurological diseases (level A), stiff-person syndrome (level A), some acute-demyelinating diseases and childhood refractory epilepsy (good practice point).

Guía colombiana de práctica clínica para el uso de inmonuglobulinas en el tratamiento de reemplazo e inmunomodulación

“…También es una buena opción en la mujer embarazada. (GRADE A1) 122,162,163,164,165 La IgIV es un recurso en la crisis miasténica con una eficacia similar a la del recambio plasmático. Rev Alerg Mex.…”

Intravenøs IgG-behandling av nevromuskulære sykdommer

“…i dose 1-2 g/ kg, har behandlingen antiinflammatorisk effekt ved en rekke nevrologiske, hematologiske, revmatologiske og dermatologiske tilstander (1). Det er tidligere utgitt europeiske retningslinjer for bruk av intravenøs IgGbehandling av nevrologiske sykdommer (2). Målet med denne artikkelen er å gi en kort oversikt over bruk av slik behandling ved nevromuskulaere sykdommer og hva som foreligger av dokumentasjon for effekt (tab 1).…”

Clinical evaluation of natalizumab for formulary consideration

“…There are a number of treatment guidelines available to clinicians to manage MS in their patients [13][14][15][16][17]. At the same time as this current research Boster et al published treatment guidelines directly pertaining to the intense treatment of MS in rapidly declining patients [13].…”