Intravenous immunoglobulin for the treatment of severe <i>Clostridium difficile</i> colitis: An observational study and review of the literature

Abougergi, Marwan S.; Broor, Apoorv; Cui, Wei; Jaar, Bernard G.

doi:10.1002/jhm.542

Cited by 82 publications

(38 citation statements)

References 48 publications

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“…However, the various inclusion criteria included pancolitis on CT scan either with or without megacolon [36,48,50], thumbprinting on CT scan [36], and a scale described by Rubin et al [49,59]. The most recent study, by Abougergi et al, provided two scales for inclusion: One based on extent of colonic disease and the other based on the APACHE II score to assess severity of systemic involvement [56].…”

Section: Ivig For Severe CDImentioning

confidence: 98%

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Intravenous Immunoglobulin for the Treatment of Clostridium difficile Infection: A Review

Abougergi

Kwon

2010

Dig Dis Sci

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Clostridium difficile infection (CDI) has increased sharply in incidence, mortality rate, and burden on the healthcare system over the past decade. Therefore, novel treatment modalities have been developed, including intravenous immunoglobulin (IVIG). The level of immune response to Clostridium difficile colonization is the major determinant of the magnitude and duration of clinical manifestations. This effect is mediated predominantly by serum IgG anti-toxin A antibodies. Based on this finding, anti-toxin A and B antibodies were successfully used in multiple in vitro and in vivo experimental settings to passively immunize hamsters in CDI models. In humans, IVIG was used as the source of those antibodies. Fifteen small, mostly retrospective and non-randomized reports documented IVIG's success in the treatment of protracted, recurrent, or severe CDI. Diarrhea resolution rates were higher in the former patient group, but the recurrence rates were similar. IVIG mechanism of action is neutralization of mainly toxin A through IgG anti-toxin A antibodies. Purified anti-toxin A and B antibodies were successfully used to decrease CDI recurrence rates among patients with no or one previous CDI episodes. In conclusion, the efficacy of IVIG for CDI treatment in animal models has been convincingly demonstrated. However, only few small non-randomized, mostly uncontrolled reports have been published on human subjects. A phase II trial results support the use of purified anti-toxin A and B antibodies to decrease CDI recurrence rates. Therefore, IVIG should currently only be used as adjunct therapy until results from large, randomized controlled trials are available.

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Section: Ivig For Severe CDImentioning

confidence: 98%

“…Its use for severe CDI was reported 7 years later [36]. Since then, a total of 15 reports have been published on IVIG for either relapsing or severe CDI treatment [25,[35][36][37][47][48][49][50][51][52][53][54][55][56][57].…”

Section: Ivig For Clostridium Difficile Infection: Outcome In Clinicamentioning

confidence: 99%

Intravenous Immunoglobulin for the Treatment of Clostridium difficile Infection: A Review

Abougergi

Kwon

2010

Dig Dis Sci

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“…Estudios limitados de tipo retrospectivo y no aleatorizados en humanos han mostrado efecto positivo de la administración de IgIV en casos selectivos, especialmente en la disminución de la diarrea, aunque sin efecto significativo en la disminución de las recurrencias. 238,239,240,241 Algunos expertos consideran que la terapia con IgIV no debe ser utilizada como adyuvante de primera línea, teniendo en cuenta que su papel no es claro, por lo que señalan la necesidad de que estén disponibles estudios controlados y aleatorizados; sin embargo, su indicación en colitis por CD puede ser selectiva para pacientes con choque, íleo o megacolon que no responden a manejo convencional escalonado. 242,243,244,245 R Dado que no hay indicación del uso de IgIV en adultos, antes se recomienda el empleo de fidaxomicina, tigeciclina e, incluso, el trasplante de microbiota fecal.…”

Section: Síndrome De Rassmussenunclassified

“…(GRADE C2) R En colitis escalonada con metronidazol, nitaxozanida o vancomicina oral grave o multirrecurrente por CD y sin respuesta a una semana de terapia convencional, se recomienda la administración de 400 mg/kg de IgIV por 1 a 4 días para reducir la morbilidad y la mortalidad. (GRADE C2) 238,240,241,242,243,246 R Se recomienda el uso de IgIV en pacientes con anemia de serie roja por parvovirus B19. (GRADE B2) 237 Enfermedad de Kawasaki La enfermedad de Kawasaki (EK) es la forma más común de vasculitis en los niños.…”

Section: Síndrome De Rassmussenunclassified

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

Olivares

Olmos²,

Álvarez

et al. 2017

RAM

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Immunoglobulins are heterodimeric proteins composed of 2 heavy chains and 2 light chains. Human immunoglobulin G (IgG) is a plasma derivative and contains more than 95% of IgG. The composition of IgG subclasses is similar to that of normal human plasma. Immunoglobulin therapy was first introduced more than 50 years ago, and its use has been described in numerous diseases. In Colombia, the importance of this immunomodulatory resource prompted the need for clinical practice guidelines to be available for its use. For this reason, a multidisciplinary group of experts was brought together and distributed in working groups, by specialties, in order to develop an initial manuscript. Systematic literature searches were undertaken; identified evidences were evaluated and classified to support a preliminary draft that was discussed, analyzed and amended. Recommendations were issued on the use of intravenous immunoglobulin in pathologies that include primary and secondary immunodeficiencies, autoimmune diseases, neurological disorders, infections, transplants and miscellaneous conditions; grades were assigned to each one of them according to the GRADE system. The final result translated into recommendations that are put forth with the purpose to inform, guide and support on optimal use of this immunomodulatory resource.

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“…Meanwhile, neutralizing antibodies to both TcdA and TcdB provided complete protection from diarrhea and death in this model. 68 In contrast to animal studies where antibodies were delivered orally or systemically, the majority of human studies thus far have used the systemic delivery route. The results of animal studies and the prevalence of serum antibodies against TcdA and TcdB in healthy populations have prompted investigators to evaluate the therapeutic activity of Intravenous immunoglobulin (IVIG) preparations in individuals experiencing severe or recurrent CDI.…”

Section: Passive Immunization Against CDImentioning

confidence: 99%

Immune-based treatment and prevention ofClostridium difficileinfection

Song

Ghose-Paul

Zhang

et al. 2014

Human Vaccines & Immunotherapeutics

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Clostridium difficile (C. difficile) causes over 500,000 infections per year in the US, with an estimated 15,000 deaths and an estimated cost of $1-3 billion. Moreover, a continual rise in the incidence of severe C. difficile infection (CDI) has been observed worldwide. Currently, standard treatment for CDI is the administration of antibiotics. While effective, these treatments do not prevent and may contribute to a disease recurrence rate of 15-35%. Prevention of recurrence is one of the most challenging aspects in the field. A better knowledge of the molecular mechanisms of the disease, the host immune response and identification of key virulence factors of C. difficilenow permits the development of immune-based therapies. Antibodies specific for C. difficile toxins have been shown to effectively treat CDI and prevent disease relapse in animal models and in humans. Vaccination has been recognized as the most cost-effective treatment/prevention for CDI. This review will summarize CDI transmission, epidemiology, major virulent factors and highlights the rational and the development of immune-based approaches against this remerging threat.

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Intravenous immunoglobulin for the treatment of severe Clostridium difficile colitis: An observational study and review of the literature

Cited by 82 publications

References 48 publications

Intravenous Immunoglobulin for the Treatment of Clostridium difficile Infection: A Review

Intravenous Immunoglobulin for the Treatment of Clostridium difficile Infection: A Review

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

Immune-based treatment and prevention ofClostridium difficileinfection

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