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Intravenous ImmunoGlobulin (IVIG) Safe & Effective In Relapsing/Remitting Multiple Sclerosis

Achiron A, Gabbay U, Gilad R, Hassin-Baer S, Barak Y, Gornish M, Elizur A, Goldhammer Y, Sarova-Pinhas I
Neurology 1998 Feb;50(2):398-402
Multiple Sclerosis Center,
Sheba Medical Center, Tel Hashomer, Israel

A study was conducted that included 40 patients between the ages of 19 to 60 with relapsing/remitting multiple sclerosis to evaluate the effect of Immunoglobulin (IVIG) on exacerbation of the disease. The patients received either IVIG or a placebo initially for a 5 day period followed by infusions every 2 months for a period of 2 years. The investigators looked at the number of patients who remained exacerbation free, the yearly exacerbation rate, the time until the first exacerbation and the severity of the exacerbations. They also evaluated the outcome of IVIG on neurologic disability and changes in brain MRI lesion scores. All patients had a baseline MRI which was repeated at 1 year and at the end of the study.

The results of the study showed a significant reduction in yearly exacerbation rate in the group that received the IVIG. Six patients in the IVIG group were exacerbation free throughout the 2-year period of the study, whereas none were exacerbation free in the placebo group. The average time to first exacerbation was 233 days in the IVIG group as compared to 82 days in the placebo group. Neurologic disability decreased by 0.3 in the IVIG group and increased by 0.15 in the placebo group. Total lesion score evaluated by Brain MRI did not show a significant difference in either group.

This study suggests that IVIG is safe and effective in reducing the frequency of exacerbations in patients with relapsing/remitting multiple sclerosis.

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Intravenous ImmuneGlobulin (IVIG) Therapy In Neurologic Diseases

Dalakas MC
Ann Intern Med. 1997 May 1;126(9):721-30
National Institute of Neurological Disorders and Stroke,
National Institutes of Health, Bethesda, MD 20892-1382, USA

High-dose IntraVenous ImmunoGlobulin (IVIG) has become an important therapy for various Neurologic Diseases such as Multiple Sclerosis. This study examined the clinical, serologic and immunologic data on 110 patients with a variety of neurologic disorders over a 6 year period. It also reviewed work by other investigators on the efficacy, risks, benefits, and mechanisms of the action of IVIG in these diseases.

A number of clinical trials and case reports indicate that IVIG had variable or mild benefits in some patients with Multiple Sclerosis and the exact action of IVIG is unknown. The author suggests that IVIG is effective in patients with autoimmune neurologic diseases, however the results vary and further controlled clinical trials are needed.

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Monthly immunoglobulin therapy improved relapsing-remitting multiple sclerosis

ACP Journal Club. 1997 Jul-Aug;127:11.
Evidence-Based Medicine. 1997 Jul-Aug;2:112.
Fazekas F, Deisenhammer F, Strasser-Fuchs S, Nahler G, Mamoli B, for the Austrian Immunoglobulin in Multiple Sclerosis Study Group. Randomised placebo-controlled trial of monthly intravenous immunoglobulin therapy in relapsing-remitting multiple sclerosis. Lancet. 1997 Mar 1;349:589-93.

This study was conducted to evaluate effectiveness of monthly IVIG therapy in improving the clinical course of relapsing-remitting multiple sclerosis. The study included 150 patients (mean age 37) with relapsing-remitting MS in 13 neurologic centers throughout Austria over a two year period. Patients received either IVIG or a placebo throughout the study. Study results suggest that the patients receiving IVIG suffered less relapses and showed clinical improvement over those receiving the placebo.

The conclusion of the investigators was that monthly infusion of intravenous immunoglobulin improved the course of clinical disability and reduced the frequency of relapses in relapsing-remitting multiple sclerosis.

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