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Intravenous immunoglobulins for relapses of systemic
vasculitides associated with antineutrophil cytoplasmic autoantibodies:
Results of a multicenter, prospective, open-label study of twenty-two
patients.
Arthritis Rheum. 2008 Jan;58(1):308-17.
Martinez V, Cohen P, Pagnoux C, Vinzio S, Mahr A, Mouthon L, Sailler L, Delaunay C, Sadoun A, Guillevin L; French Vasculitis Study GroupSee Appendix A for members of the French Vasculitis Study Group.
Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France.
OBJECTIVE:
To evaluate at 9 months and 24 months the safety and efficacy of
intravenous immunoglobulins (IVIGs) administered for 6 months to treat
relapses of Wegener's granulomatosis (WG) or microscopic polyangiitis
(MPA) occurring either under treatment or during the year following
discontinuation of corticosteroids and/or immunosuppressants.
METHODS:
Patients received IVIGs (0.5 gm/kg/day for 4 days) as additional
therapy administered monthly for 6 months and were assessed every 3-6
months. Corticosteroids could be maintained or reintroduced at the time
of relapse; immunosuppressants could be continued but could not be
reintroduced. At months 9 (end point) and 24 (followup), the following
information was collected: complete or partial remission, relapse as
assessed with the Birmingham Vasculitis Activity Score (BVAS) 2005, and
tolerance and safety of IVIG therapy. RESULTS: Twenty-two Caucasian
patients (7 men and 15 women) were studied: 19 had WG, and 3 had MPA.
Their median age was 53 years (range 19-75 years), and their median
duration of systemic vasculitis was 27 months (range 7-109 months).
Their median BVAS 2005 score was 11 (range 3-25). At study entry, 21
patients were ANCA positive, and 21 patients were taking steroids
and/or immunosuppressants. All patients experiencing relapse were
treated with the same drug(s) plus IVIGs. All patients initially
responded to IVIG therapy. By month 9, 13 patients had complete
remission, 1 had partial remission, 7 had relapse, and 1 had treatment
failure. In 8 of the 14 patients who had remission, the response
persisted at month 24. Seven patients experienced minor side effects.
CONCLUSION: IVIGs induced complete remissions of relapsed
ANCA-associated vasculitides in 13 of 22 patients at month 9. Because
of the good safety and tolerance profiles of IVIGs, these agents can be
included in a therapeutic strategy with other drugs used to treat
relapses of WG or MPA.
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