A number of autoimmune disorders have been identified in which
IVIg treatment may be beneficial. Evidence for the use of
IVIg in
inflammatory myopathies comes from controlled trials in
dermatomyositis (DM) and
sporadic-inclusion body myositis (s-IBM). In DM, muscle strength was increased and neuromuscular scores and skin rashes improved. Results for s-IBM have not been as encouraging as those observed for DM. Subsequently,
IVIg should be recommended as a second-line
therapy in DM and used for life-threatening
dysphagia in s-IBM. Using an animal model of
experimental autoimmune myasthenia gravis (MG), studies also indicate that
IVIg can significantly improve clinical symptoms and affect pathogenic idiotypic
antibodies. In human MG, studies indicate that
IVIg exhibited equal efficacy compared to
plasmapheresis.
IVIg can therefore be recommended for use in an MG crisis or in lieu of
plasmapheresis. The role of
IVIg in the chronic management of MG has not been studied.
IVIg has also been investigated in autoimmune CNS disorders. In a controlled study in patients with
stiff person syndrome IVIg was effective, with improvements in the distribution of stiffness index and heightened sensitivity scores. For
neurodegenerative diseases such as
Alzheimer's disease,
post-polio syndrome,
pain,
fibrosis, and autoimmune
sleep disorders, some early promising results for the use of
IVIg are emerging, but remain to be fully investigated. In conclusion,
IVIg appears to be an effective treatment for a number of autoimmune disorders, however, optimal dosing and pharmacogenetic studies are necessary.