Ambulantná terapia 1/2009

Intravenous immunoglobulin therapy for neurologic disorders: an update and practical issues

Over the past decade we have observed considerable advances in the treatment of autoimmune-mediated neurological disorders. Part of this development was the introduction of high-dose polyclonal intravenous immunoglobulins (IVIg). On the basis of randomised, placebo controlled, double-blind clinical trials, IVIg has became a first-line therapy for Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy. Furthermore, IVIg plays an important role in treating myasthenic crises and exacerbations in myasthenia gravis, and IVIg may play a role in selected chronic treatment-refractory cases of polymyositis, dermatomyositis, Lambert-Eaton myasthenic syndrome, acquired neuromyotonia and stiff-person syndrome. Due to excellent safety profile and its uncomplicated administration, IVIg has been used very liberally for most diseases with suspected autoimmune pathology or where there is no treatment available. This, and the strict licensing requirements, has led to a shortage in IVIg supply and dramatic inrease in costs. Therefore, IVIg should be principally be used according to available data from controlled clinical trials. Here we review the clinical applications and recommendations for the use of IVIg in neurological diseases.

Keywords: autoimmune-mediated neurologic disorders, immune-modulating therapy, IVIg, indications, results, side-effects, recommendations for practice