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Drug Insight: the use of intravenous immunoglobulin in neurology-therapeutic considerations and practical issues.
Nat Clin Pract Neurol. 2007 Jan;3(1):36-44.
Gold R, Stangel M, Dalakas MC.
R
Gold chairs the Department of Neurology at St Josef Hospital,
University of Bochum, and M Stangel is a consultant in the Department
of Neurology, Medical School of Hannover and a member of the Center for
Systems Neuroscience, Hannover, Germany.
Over the past few
years, we have achieved increasing success in the treatment of a number
of autoimmune-mediated disorders affecting nerves and muscles.
This
success is partly attributable to the use of high-dose polyclonal
intravenous immunoglobulin (IVIg), which has dramatically changed our
treatment options. On the basis of results from controlled, but
non-FDA-approved, clinical trials, IVIg is now the treatment of choice
for Guillain-Barre syndrome, chronic idiopathic inflammatory
demyelinating polyneuropathy and multifocal motor neuropathy; IVIg
offers rescue therapy for patients with rapidly worsening myasthenia
gravis, and is a second-line therapy for dermatomyositis, stiff-person
syndrome, and pregnancy-associated or postpartum multiple sclerosis
attacks. The ability of IVIg to treat such immunologically diverse
disorders effectively, coupled with its excellent safety profile, has
led clinicians to use the drug more liberally, even in diseases for
which the data are weak and not evidence-based and in patients with
coexisting conditions. Use of IVIg for such indications can increase
the risk of complications while raising the cost of the drug. Practical
issues regarding dosing and frequency of infusions generate dilemmas in
clinical practice. In this article, we review the current indications
for IVIg treatment, address practical issues related to the use and
costs of the drug, and summarize its mechanisms of action.
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