INTRAVENOUS IMMUNOGLOBULINS IN THE THERAPY OF AUTOIMMUNE AND SYSTEMIC INFLAMMATORY DISORDERS

Objective: The focus of this review is to summarize the mechanism and the adverse side-effects of Intravenous Immunoglobulin (IVIg) therapy, and to highlight the current cumulative experience of its use in the treatment and management of autoimmune and systemic inflammatory diseases. Data sources: Detailed search of the literature was done. Studies involving only humans were considered for clinical evaluation. Animal studies were used only for understanding mechanisms of action. The NIH Consensus Conference of May 1990 and the Australian Society for Blood Transfusion of July 1993 were used for guidelines. Study Selection: Material was taken only from peer reviewed journals. Results: It appears that IVIg may act by more than one mechanism of action. It is unclear whether the mechanism is different in different diseases and whether more than one mechanism may apply to any disease or clinical state. The incidence and gravity of serious side effects appears low. It is the mainstay of treatment of immune thrombocytopenia purpura and Kawasaki disease. Conclusion: IVIg is a safe and effective therapeutic modality that can be added to the repertoire of various agents used to treat autoimmune and systemic inflammatory diseases. Long-term prospective studies are needed to define indications, dose-schedules, duration of therapy, and influence on the clinical courses of chronic diseases better.