Indications for IVIG in Rheumatic Diseases
IVIG has been shown to be effective in treating Kawasaki disease, ITP, CIDP and GBS with good supporting evidence. There is also evidence for its second-line use in DM/PM and as a bridging therapy in some cases of AAV. Certain subsets of SLE patients may also benefit from IVIG during acute flares. The overall safety profile for IVIG is good, with only minor transfusion reactions being reported throughout the literature. That said, and of relevance in rheumatological practice, there is an increased risk of thromboembolism of up to 2% when given in high doses. For this reason, slow infusion with the lowest concentration available is warranted.
It has been difficult to gather conclusive results on the efficacy of IVIG in the rheumatic diseases due to the rarity and heterogeneity of these diseases. The shortage of robust research has led to the NDMP placing many of these diseases in a category that requires more justification before IVIG use can be authorized, the main intention of the NDMP being that IVIG use is allocated to those conditions where the benefit has been demonstrated to be greatest. This review has provided justification for the use of IVIG in some of the rheumatic diseases by summarizing the current available evidence.
It is obvious that there is a clear need for further study in rheumatic conditions, including setting up national RCTs for the rheumatic indications of IVIG. Although this review has focused on summarizing the evidence for the rheumatic conditions that may benefit from IVIG, it is hoped that it may also act as a guide for future areas of research and help to standardize IVIG dosing and use in the treatment of these rare and less well-understood diseases.
Conclusion
IVIG has been shown to be effective in treating Kawasaki disease, ITP, CIDP and GBS with good supporting evidence. There is also evidence for its second-line use in DM/PM and as a bridging therapy in some cases of AAV. Certain subsets of SLE patients may also benefit from IVIG during acute flares. The overall safety profile for IVIG is good, with only minor transfusion reactions being reported throughout the literature. That said, and of relevance in rheumatological practice, there is an increased risk of thromboembolism of up to 2% when given in high doses. For this reason, slow infusion with the lowest concentration available is warranted.
It has been difficult to gather conclusive results on the efficacy of IVIG in the rheumatic diseases due to the rarity and heterogeneity of these diseases. The shortage of robust research has led to the NDMP placing many of these diseases in a category that requires more justification before IVIG use can be authorized, the main intention of the NDMP being that IVIG use is allocated to those conditions where the benefit has been demonstrated to be greatest. This review has provided justification for the use of IVIG in some of the rheumatic diseases by summarizing the current available evidence.
It is obvious that there is a clear need for further study in rheumatic conditions, including setting up national RCTs for the rheumatic indications of IVIG. Although this review has focused on summarizing the evidence for the rheumatic conditions that may benefit from IVIG, it is hoped that it may also act as a guide for future areas of research and help to standardize IVIG dosing and use in the treatment of these rare and less well-understood diseases.
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