Improvement of Intravenous Immunoglobulin Therapy for Bullous Pemphigoid by Adding Immunosuppressive Agents

Retrospective analysis of a single‐center clinical experience toward development of curative treatment of 123 pemphigus patients with a long‐term follow‐up: efficacy and safety of the multidrug protocol combining intravenous immunoglobulin with the cytotoxic immunosuppressor and mitochondrion‐protecting drugs

“…IVIg, 2 g/kg/month, was given on 4–5 consecutive days as a slow, approximately 4‐hour infusion, hereinafter referred to as “IVIg cycle.” Prior to each infusion, the patients were premedicated with 50 mg diphenhydramine and 500 mg acetaminophen. To prevent a rebound effect from compensatory overproduction of pemphigus antibodies by the autoantibody‐producing cells stimulated via a negative feedback due to rapid clearance of pathogenic IgGs, IVIg was combined with the ICD mycophenolate mofetil 2 g/day, azathioprine 200 mg/day, or cyclophosphamide 150 mg/day, chosen in the above order depending on the patient's insurance allowance as well as counter‐indications and adverse reactions (Fig. a).…”

Intravenous immunoglobulin G in the treatment of autoimmune bullous disease

“…In addition to pemphigus, we have studied the effect of IVIg in combination with a cytotoxic agent in a 78‐year‐old patient with autoantibody‐mediated bullous pemphigoid . The patient had multiple cycles of IVIg treatment, with or without immunosuppressants on an alternating schedule, over a period of 20 months.…”