Intravenous immunoglobulin in relapsing-remitting multiple sclerosis - A dose-finding trial

Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, A-8036 Graz, Austria.
Neurology (Impact Factor: 8.29). 07/2008; 71(4):265-71. DOI: 10.1212/01.wnl.0000318281.98220.6f
Source: PubMed


Several studies have reported a reduction of relapses after the long-term administration of IV immunoglobulin (IVIG) to patients with relapsing-remitting multiple sclerosis (RRMS), but they were mostly small and differed in terms of predefined outcome variables and treatment regimen. We therefore set out to test two different doses of a new formulation of immunoglobulin termed IGIV-C 10% for suppression of both clinical and MRI disease activity as well as safety.
One hundred twenty-seven patients with RRMS participated in this multicenter, randomized, double-blind, placebo-controlled trial. Forty-four and 42 patients received treatment with 0.2 and 0.4 g/kg of IGIV-C 10%, and 41 patients received an equal volume of placebo (0.1% albumin) every 4 weeks for 48 weeks. The primary endpoint was the proportion of relapse-free patients. The main secondary endpoint was lesion activity assessed by 6-weekly MRI.
Baseline variables were similar in IVIG- and placebo-treated groups. After 1 year, the proportion of relapse-free patients did not differ statistically according to treatment (IVIG 0.2 g/kg: 57%; IVIG 0.4 g/kg: 60%; placebo: 68%), and there was no difference regarding the cumulative number of unique newly active MRI lesions (median numbers: IVIG 0.2 g/kg: 8.0; IVIG 0.4 g/kg: 5.0; placebo: 7.2) after 48 weeks. There were no significant between-group differences in the rates of adverse events.
Although IV immunoglobulin (IVIG) treatment was well tolerated, this study did not substantiate a beneficial effect of IVIG in doses ranging from 0.2 to 0.4 g/kg. This result seriously questions the utility of IVIG for the treatment of relapsing-remitting multiple sclerosis.

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Available from: David K B Li, Jul 01, 2015
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    • "nt by some authors studying postnatal relapses ( Fazekas et al . , 2008 ; Hellwig et al . , 2009 ) . Some authors recommend the use of immunoglobulin as a therapeutic option for MS when usual immunomodulatory drugs are inefficient ( Dudesek & Zettl , 2006 ) . Other authors , however , question whether there is indeed a response to this treatment ( Fazekas et al . , 2008 ) and whether the price paid for it is justifiable ( Elovaara & Hietaharju , 2010 ) ."
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