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The current place of high‐dose immunoglobulins in the treatment of neuromuscular disorders
Author(s) -
van der Meché Frans G. A.,
van Doorn Pieter A.
Publication year - 1997
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/(sici)1097-4598(199702)20:2<136::aid-mus1>3.0.co;2-d
Subject(s) - medicine , multifocal motor neuropathy , chronic inflammatory demyelinating polyneuropathy , myasthenia gravis , dermatomyositis , polymyositis , prednisone , rituximab , clinical trial , immunology , antibody , mismatch negativity , electroencephalography , psychiatry
High‐dose immunoglobulins for intravenous administration (IVIg) have originally been developed for substitution therapy in hypogammaglobulinemia. Over the last decade they are increasingly used in the treatment of immune‐mediated diseases. In this review the results in immune‐mediated neuromuscular diseases are summarized. Positive effects are demonstrated in open studies in dermato‐ and polymyositis, myasthenia gravis, and inflammatory neuropathies. Properly conducted randomized clinical trials demonstrating the effect of IVIg are available in dermatomyositis, Guillain‐Barré syndrome, and chronic inflammatory demyelinating polyneuropathy, and smaller ones in multifocal motor neuropathy. In myasthenia gravis a trial is at present underway and only interim results are available. The results of a trial in the Lambert‐Eaton myasthenic syndrome are in the process of publication. The therapeutic approach in individual patients is discussed, but often appears to be difficult. Considering chronic treatment with IVIg, proper long‐term studies including cost‐benefit studies are needed. Future developments aim for combination therapies, since IVIg and immune suppressants like prednisone are suggested to have a synergistic effect. © 1997 John Wiley & Sons, Inc. Muscle Nerve, 20, 136–147, 1997.