Intravenous immunoglobulin therapy in autoimmune diseases

A better understanding of the immunomodulating mechanisms of immune globulins in the last decade is the rationale for the expansion of intravenous immune globulin (ivIg) therapy in a wide spectrum of diseases with a significant or suspected autoimmune component. There are a number of anecdotal reports showing that ivIg therapy may be beneficial in certain diseases. Only in a few diseases the effect of ivIg has been proven in controlled trials. The present recommendation for the use of ivIg is restricted to selected forms of immunothrombocytopenic purpura (ITP) and in Kawasaki's disease. There is still no indication for considering the use of ivIg as initial therapy in adults. It is estimated that as much as 80% of the ivIg currently used is for non-approved indications. Failure of conventional treatment, severe side effects of corticosteroids and other immunosuppressive agents or contraindications against the standard therapy are the main reasons for the use of ivIg as an alternative or adjunctive therapy. More information about the pathological mechanisms of autoimmunity and the immunomodulating effects of ivIg is needed to complete more controlled studies in those diseases where available data suggest a potential benefit of ivIg. Cost/benefit aspects, the risk of side effects and the possibility of deterioration in some cases are important factors that should make physicians cautious about using ivIg for non-approved indications.