Analysis Finds IVIG is a Viable Approach for Autoimmune Neurological Diseases

Intravenous immunoglobulin was more effective than placebo, but not more effective than plasmapheresis and corticosteroids.

A new literature review has found that intravenous immunoglobulin (IVIG) can be considered a viable therapeutic approach as either first- or second-line therapy and as an adjuvant therapy for patients with autoimmune neurological diseases.

Corticosteroids are the first-line treatment for several common autoimmune neurological diseases. These diseases are caused by a loss of self-tolerance due to abnormal immune responses to self-structures, which can result in damage persisting over time. These diseases are typically accompanied by inflammation, loss of tolerance, autoantibody production, and tissue damage. Available treatments include corticosteroids, IVIG, and plasmapheresis.

Some research has shown potential benefits with IVIG therapy in various conditions, but few studies have examined the relative efficacy of IVIG compared with plasmapheresis or corticosteroids. In a 2021 study, for example, researchers found that if IVIG is commenced within 2 weeks of onset of Guillain-Barré syndrome, it may be able to hasten recovery as much as plasma exchange. However, there are little data about optimal dose and whether IVIG would be efficacious in cases of Guillain-Barré lasting more than 2 weeks.

To better understand the use of IVIG in autoimmune neurological conditions, investigators searched PubMed, MEDLINE, Embase, and Cochrane databases for relevant studies of Guillain-Barré syndrome, myasthenia gravis, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), optic neuritis, autoimmune encephalitis, and multiple sclerosis. The search included articles published up to November 2021.

Controlled, randomized studies comparing the efficacy of IVIG with placebo, plasmapheresis, and/or glucocorticoid administration were considered eligible. Only studies reporting the number of patients who improved after treatment were included, regardless of language or publication year. Twenty-three studies that met the selection criteria were included in the study.

The investigators found that in autoimmune neurological diseases, IVIG was more effective than placebo, but not more effective than plasmapheresis and corticosteroids. However, it could still be a valuable therapeutic alternative, either as a first- or second-line treatment or as an adjuvant in the treatment of these diseases.

The meta-analysis did show a beneficial effect of IVIG on patient improvement and virtually identical effects to plasmapheresis. No significant differences were found in the efficacy of IVIG and glucocorticoid administration.

Use of IVIG has grown significantly in recent years, although there are still many questions about optimal dosages, disease states, and patient characteristics. Current development efforts are focused on new routes of administration for immunoglobulin that can overcome the limitations of intramuscular administration, such as IVIG.

REFERENCE

Morales-Ruiz V, Juarez-Vaquera VH, Rosetti-Scuitto M, Sanchez-Muñoz F, and Adalid-Peralta L. Efficacy of intravenous immunoglobulin in autoimmune neurological diseases. Literature systematic review and meta-analysis. Autoimmunity Reviews. March 22. Accessed October 7, 2022. https://www.sciencedirect.com/science/article/abs/pii/S1568997221003013?via%3Dihub