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Use of intravenous immunoglobulin for treatment of recurrent miscarriage: a systematic review.
BJOG. 2006 Dec 12
Hutton B, Sharma R, Fergusson D, Tinmouth A, Hebert P, Jamieson J, Walker M.
Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada.
Background
Intravenous immunoglobulin (IVIG) is a fractionated blood product whose
off-label use for treating a variety of conditions, including
spontaneous recurrent miscarriage, has continued to grow in recent
years. Its high costs and short supply necessitate improved guidance on
its appropriate applications.
Objective We conducted a systematic
review of randomised controlled trials evaluating IVIG for treatment of
spontaneous recurrent miscarriage. Search strategy A systematic search
strategy was applied to Medline (1966 to June 2005) and the Cochrane
Register of Controlled Trials (June 2005). Selection criteria We
included all randomised controlled trials comparing all dosages of IVIG
to placebo or an active control. Data collection and analysis Two
investigators independently extracted data using a standardised data
collection form. Measures of effect were derived for each trial
independently, and studies were pooled based on clinical and
methodologic appropriateness. Main results We identified eight trials
involving 442 women that evaluated IVIG therapy used to treat recurrent
miscarriage. Overall, IVIG did not significantly increase the odds
ratio (OR) of live birth when compared with placebo for treatment of
recurrent miscarriage (OR 1.28, 95% CI 0.78-2.10). There was, however,
a significant increase in live births following IVIG use in women with
secondary recurrent miscarriage (OR 2.71, 95% CI 1.09-6.73), while
those with primary miscarriage did not experience the same benefit (OR
0.66, 95% CI 0.35-1.26). Author's conclusions IVIG increased the rates
of live birth in secondary recurrent miscarriage, but there was
insufficient evidence for its use in primary recurrent miscarriage.
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