Objective To evaluate the efficacy and safety of different doses of intravenous immunoglobulin (IVIG) in the treatment of relapsing-remitting multiple sclerosis (RRMS).
Methods We searched for randomized controlled trials of different doses of IVIG in the treatment of RRMS. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses with The Cochrane Collaboration’s Revman 4.2.0 software.
Results Three randomized controlled trials of different dose of IVIG in the treatment of RRMS were included. One was of high quality and the other two were of lower quality. Heterogeneity was identified in one study which reported IVIG in postpartum RRMS. Two studies reported the relapsefree rate and no significant difference was noted between IVIG and placebo. Two studies reported the annual relapse rate, and no significant difference was observed (OR -0.00, 95% CI -0.36 to 0.36, P=0.98). Two studies reported the MRI lesions, and no difference was identified, either. The incidence of adverse events was similar between IVIG and placebo.
Conclusion There is insufficient evidence to support the dose-effect relationship of IVIG in the treatment of RRMS. Therefore, an individualized dosing regimen should be applied according to patients’ tolerance and economic status.
Citation：
WU Fengbo,XU Pingrong,JIA Ping,LI Jian,TANG Yao. Efficacy and Safety of Different Doses of Intravenous Immunoglobulin in the Treatment of Relapsing-Remitting Multiple Sclerosis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(11): 997-1000. doi: 10.7507/1672-2531.20080219
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Copyright © the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
| 1. |
Fazekas F, Deisenhammer F, Strasser-Fuchs S, et al. Randomised placebo-controlled trial of monthly intravenous immunoglobulin therapy in relapsing-remitting multiple sclerosis. Lancet, 1997, 349(9052): 589- 593.
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| 2. |
Durelli L, Isoardo G. High-dose intravenous immunoglobulin treatment of multiple clerosis. Neurol Sci, 2002, 23(suppl): 39-48.
|
| 3. |
Teksam M , Tali T, Kocer B, et al. Qualitative and quantitative volumetric evaluation of the efficacy of intravenous immunoglobulin in multiple sclerosis: preliminary report. Neuroradiology, 2000, 42(12): 885-889.
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| 4. |
Achiron A, Gabbay U, Gilad R, et al. Intravenous immunoglobulin treatment in multiple sclerosis: effect on relapses. Neurology, 1998, 50(2): 398-402.
|
| 5. |
Juni P, Altman DG, Eger M. Assessing the quality of controlled clinical trails. BMJ, 2001, 323(7303): 42-46.
|
| 6. |
Fazekas F, Lublin FD, Li D, et al. Intravenous immunoglobulin in relapsing-remitting multiple sclerosis: a dose-finding trial. Neurology, 2008, 71(4): 265-271.
|
| 7. |
Lewańska M, Siger-Zajdel M, Selmaj K. No difference in efficacy of two different doses of intravenous immunoglobulins in MS: clinical and MRI assessment. Eur J Neurol, 2002, 9(6): 565-572.
|
| 8. |
Haas J, Hommes OR. A dose comparison study of IVIG in postpartum relapsing-remitting multiple sclerosis. Mult Scler, 2007, 13(7): 900-908.
|
| 9. |
Dalakas MC. Intravenous immune globulin therapy for neurologic diseases. Ann Intern Med, 1997, 126(9): 721-730.
|
- 1. Fazekas F, Deisenhammer F, Strasser-Fuchs S, et al. Randomised placebo-controlled trial of monthly intravenous immunoglobulin therapy in relapsing-remitting multiple sclerosis. Lancet, 1997, 349(9052): 589- 593.
- 2. Durelli L, Isoardo G. High-dose intravenous immunoglobulin treatment of multiple clerosis. Neurol Sci, 2002, 23(suppl): 39-48.
- 3. Teksam M , Tali T, Kocer B, et al. Qualitative and quantitative volumetric evaluation of the efficacy of intravenous immunoglobulin in multiple sclerosis: preliminary report. Neuroradiology, 2000, 42(12): 885-889.
- 4. Achiron A, Gabbay U, Gilad R, et al. Intravenous immunoglobulin treatment in multiple sclerosis: effect on relapses. Neurology, 1998, 50(2): 398-402.
- 5. Juni P, Altman DG, Eger M. Assessing the quality of controlled clinical trails. BMJ, 2001, 323(7303): 42-46.
- 6. Fazekas F, Lublin FD, Li D, et al. Intravenous immunoglobulin in relapsing-remitting multiple sclerosis: a dose-finding trial. Neurology, 2008, 71(4): 265-271.
- 7. Lewańska M, Siger-Zajdel M, Selmaj K. No difference in efficacy of two different doses of intravenous immunoglobulins in MS: clinical and MRI assessment. Eur J Neurol, 2002, 9(6): 565-572.
- 8. Haas J, Hommes OR. A dose comparison study of IVIG in postpartum relapsing-remitting multiple sclerosis. Mult Scler, 2007, 13(7): 900-908.
- 9. Dalakas MC. Intravenous immune globulin therapy for neurologic diseases. Ann Intern Med, 1997, 126(9): 721-730.
