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Intravenous Immunoglobulin as an Immunomodulating Agent in Antineutrophil Cytoplasmic Antibody–Associated Vasculitides: A French Nationwide Study of Ninety‐Two Patients
Author(s) -
Crickx Etienne,
Machelart Irène,
Lazaro Estibaliz,
Kahn JeanEmmanuel,
CohenAubart Fleur,
Martin Thierry,
Mania Alexandre,
Hatron PierreYves,
Hayem Gilles,
BlanchardDelaunay Claire,
de Moreuil Claire,
Le Guenno Guillaume,
Vandergheynst Frédéric,
Maurier François,
Crestani Bruno,
Dhote Robin,
Silva Nicolas Martin,
Ollivier Yann,
Mehdaoui Anas,
Godeau Bertrand,
Mariette Xavier,
Cadranel Jacques,
Cohen Pascal,
Puéchal Xavier,
Le Jeunne Claire,
Mouthon Luc,
Guillevin Loïc,
Terrier Benjamin
Publication year - 2016
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.39472
Subject(s) - medicine , microscopic polyangiitis , anti neutrophil cytoplasmic antibody , discontinuation , granulomatosis with polyangiitis , adverse effect , vasculitis , population , refractory (planetary science) , antibody , immunology , gastroenterology , disease , physics , environmental health , astrobiology
Objective Intravenous immunoglobulin (IVIG) represents a therapeutic alternative in antineutrophil cytoplasmic antibody–associated vasculitides (AAV), but its efficacy has been evaluated in only 2 small prospective trials. The aim of this study was to evaluate the efficacy and safety of IVIG in patients with AAV. Methods We conducted a nationwide retrospective study of patients who received IVIG as immunomodulatory therapy for AAV. Results A total of 92 patients (mean age 51 years) presenting with either granulomatosis with polyangiitis (Wegener's) (68%), eosinophilic granulomatosis with polyangiitis (Churg‐Strauss) (22%), or microscopic polyangiitis (10%) received at least 1 course of IVIG. Antineutrophil cytoplasmic antibodies were present in 72% during the flare that required IVIG, as determined by immunofluorescence assay. IVIG was initiated because of relapsing disease in 83% of cases. IVIG was given for a median of 6 months (range 1–156 months) and in combination with corticosteroids in 21% of the patients or with other immunosuppressive agents in 77%. Efficacy of IVIG was assessed in the entire population and in a subset of 34 patients with unmodified background therapy. Remission rates at 6 months were 56% in the entire population and 58% in the unmodified background therapy group. Refractory disease and treatment failure at 6 months were observed in 7% and 18% in the whole population and 3% and 21% in the unmodified background therapy group, respectively. Adverse events (AEs) occurred in 33%, including serious AEs in 12% and AEs leading to discontinuation of IVIG in 7%. Conclusion This large study shows the clinical benefit of IVIG as adjunctive therapy, with an acceptable tolerance profile, and thus supports its use in AAV patients with refractory or relapsing disease.