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2014 ; 93
(16
): e86
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Intravenous immunoglobulin in the therapeutic armamentarium of systemic lupus
erythematosus: a systematic review and meta-analysis
#MMPMID25310743
Sakthiswary R
; D'Cruz D
Medicine (Baltimore)
2014[Oct]; 93
(16
): e86
PMID25310743
show ga
Prepared from the plasma of thousands of blood donors, therapeutic intravenous
immunoglobulin (IVIg) mostly consists of human polyspecific immunoglobulin G
(IgG). The use of IVIg in systemic lupus erythematosus (SLE) is still considered
experimental without any clear indications. The purpose of this systematic review
is, therefore, to evaluate the available evidence to determine the therapeutic
role of IVIg in SLE. A comprehensive, computerised search was performed in the
MEDLINE (Pubmed), Scopus, EMBASE, and Cochrane controlled trials. The study
eligibility criteria were randomized controlled trials, and prospective and
retrospective observational studies that examined the efficacy of IVIg in adult
patients with SLE who were considered the participants.IVIg therapy was the mode
of intervention in these patients. Data abstracted included the study design,
study population, changes in the disease activity scores (Systemic Lupus
Erythematosus Disease Activity Index, Systemic Lupus Activity Measure, and Lupus
Activity Index-Pregnancy), steroid dose, complement levels, autoantibodies, and
renal function. Thereafter, data analysis established statistical procedures for
meta-analysis. Thirteen studies (including 3 controlled and 10 observational)
were eligible for inclusion. There was significant reduction in the SLE disease
activity scores with IVIg therapy with a standard mean difference of 0.584 (P =
0.002, 95% confidence interval [CI] 0.221-0.947). In terms of rise in complement
levels, the response rate was 30.9% (P = 0.001, 95 CI 22.1-41.3). The effects of
IVIg on other clinical outcome measures including anti-double-stranded DNA,
antinuclear antibody, average steroid dose, and renal function could not be
determined because of the limited numbers of trials. The limitations of this
review were lack of well-designed controlled trials with adequate sample size on
the use of IVIg in SLE. In conclusion, the use of IVIg is associated with
significant reduction in SLE disease activity and improvement in complement
levels.
|Adult
[MESH]
|Humans
[MESH]
|Immunoglobulins, Intravenous/*therapeutic use
[MESH]