Intravenous Immunoglobulin

The exact mechanisms of action of intravenous immunoglobulin (IVIg) are unknown, but there is evidence for the solubilization of immune complexes or anti-idio-typic down-regulation of autoantibody production as well as induction of immuno-modulating cytokines such as transforming growth factor p and IL-10 (Ballow 1997, McMurray 2001, Rutter and Luger 2002). Considering the role of autoantibodies such as anti-ds-DNA antibodies in the pathogenesis of SLE, treatments such as IVIg designed to remove or neutralize these antibodies seemed to be promising. IVIg is currently approved for the treatment of Kawasaki disease, immune thrombocy-topenic purpura, and Guillain-Barre syndrome. In addition, skin diseases such as autoimmune blistering diseases, scleroderma, and dermatomyositis have been successfully treated with IVIg. Some studies using IVIg for the management of LE indicate improvement in nephritis, SLAM scores, myocardial dysfunction, cerebritis, and autoantibodies titers (Levy et al. 2000, Traynor et al. 2000). Moreover, IVIg was effectively used in two patients with SLE and acquired factor VII inhibition who failed to respond to corticosteroids or other immunosuppressive agents (Lafferty et al. 1997). In another study, 10 patients with refractory skin lesions were treated with 1 g/kg per day for 2 days monthly. Although an excellent response was reported in 4 of the 10 patients, the improvement was short lived (Callen 2002). One patient with antimalar-ial-resistant DLE (Genereau et al. 1999) that could not receive thalidomide because of cutaneous adverse drug reaction was treated with high-dose IVIg (2g/kg per month) in combination with hydroxychloroquine sulphate and topical betamethasone dipro-pionate. The skin lesions improved within 3 months and almost completely disappeared after 6 months. In none of the reported studies were severe adverse events observed. Controlled clinical trials are required to further evaluate the efficacy of IVIg in the treatment of LE. Furthermore, for economical reasons, the long-term application of IVIg may be limited.

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