IVIG in APS pregnancy.
ABSTRACT For more than two decades, the intravenous administration of high doses of IgG pooled from the plasma of healthy donors (immune globulin therapy, also known as 'IVIG') has benefited patients with a variety of autoimmune disorders. A potential therapeutic role of IVIG in the prevention of thrombosis and of miscarriages in antiphospholipid syndrome (APS) has been postulated. Multicenter randomized controlled trials attempted to define the role of IVIG in preventing pregnancy complications in APS indicate that simple anticoagulation could not be completely satisfactory, and certain patient subgroups might take advantage of IVIG therapy alone or in combination with heparin.
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ABSTRACT: Despite the increasing use of intravenous immunoglobulin (IVIG) in obstetrics, information on its pharmacokinetics and optimal dosing during each trimester pregnancy is lacking. The aim of this study was to characterize IVIG pharmacokinetics in pregnant women with a history of idiopathic secondary recurrent miscarriage or obstetrical antiphospholipid syndrome and to make dosing recommendations by comparing serum immunoglobulin G (IgG) concentrations in women receiving IVIG to placebo controls, before and during pregnancy. Women enrolled in an IVIG trial for idiopathic secondary recurrent miscarriage (n = 25) or an IVIG study for obstetrical antiphospholipid syndrome (n = 10); 22 received IVIG 0.5-1.0 g/kg and 13 received the equivalent volume of saline, every 4 weeks from pre-pregnancy until 18-20 weeks of gestation, with dosing adjusted for her weight prior to each infusion. Serum IgG concentrations were measured by rate nephelometry before and 0.5 h, and 1, 2, 3 and 4 weeks following an infusion. Sampling was performed pre-pregnancy and in the first and second trimesters. Area under the curve (AUC) did not differ significantly within the IVIG group between the three sampling periods. Estimated contributions of IVIG [calculated as mean AUC (IVIG group) minus mean AUC (control group)] were 4890.8 g h/l pre-pregnancy, 5591.4 g h/l first trimester and 4755.1 g h/l second trimester (P> 0.05, non-significant). For the IVIG 0.5 and 1.0 g/kg subgroups, the overall estimated contribution of exogenous IVIG was ~4000 and ~6400 g h/l, respectively. With a weight-adjusted dosage of IVIG, drug exposure, based on AUC calculations, was maintained at the pre-pregnancy level. Therefore, we recommend a weight-adjusted dosage of IVIG during the first and second trimesters.Human Reproduction 09/2011; 26(9):2283-8. · 4.67 Impact Factor
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ABSTRACT: We encountered a woman who had a history of repeated fetal losses and positive tests for lupus anticoagulant, phosphatidylserine-dependent antiprothrombin (aPS/PT) IgG, IgM and kininogen-dependent antiphosphatidylethanolamine (aPE) IgG, IgM. Her previous pregnancy had ended in intrauterine fetal death at 24weeks of gestation despite a therapy of low-dose aspirin, prednisolone and danaparoid. During the present pregnancy, she was treated with repeated intravenous infusions of immunoglobulin (IVIg) together with low-dose aspirin, prednisolone and heparin. When thrombocytopenia developed, she delivered a female baby weighing 2,152g at 34weeks of gestation by cesarean section. Titers of aPS/PT IgM and aPE IgM were reduced or maintained at low levels by repeated IVIg therapies. The IVIg therapy might be effective for aspirin-heparinoid-resistant antiphospholipid syndrome. KeywordsAntiphospholipid syndrome-Aspirin-Heparin-Heparinoid-ImmunoglobulinReproductive Medicine and Biology 04/2012; 9(4):217-221.
- 04/2012; , ISBN: 978-953-51-0526-8