Abstract | OBJECTIVE: METHODS: Thirty-five adult white patients (20 female, 15 male, mean age 43.5 years [SD 16.8]) with chronic, refractory polymyositis were treated with high doses of IVIG, after the patients had received the following traditional treatments: prednisone (n = 35), methotrexate (n = 24), azathioprine (n = 13), cyclophosphamide (n = 4), cyclosporine (n = 7), chlorambucil (n = 1), plasmapheresis (n = 8), lymphopheresis (n = 1), and total body irradiation (n = 1). There had been no changes in the patients' treatment in the 2 months before the initiation of IVIG therapy, and doses were not increased during IVIG treatment. We used preparations of polyvalent human IVIG with increased concentrations of intact IgG. The patients received 1 gm/kg/day for 2 consecutive days per month. The mean course of treatment was 4-6 months. The clinical assessment involved the evaluation of proximal muscle power, muscle disability scale score, and esophageal disorders. The biochemical evaluations carried out before each treatment period were compared by Student's t-test and nonparametric Wilcoxon test. Results were considered to be significant at P = 0.05. RESULTS: In the short-term, significant clinical improvement was noted in 25 of the 35 patients (71.4%). Mean muscle power was estimated before and after IVIG therapy and was found to be significantly improved (P < 0.01). All patients had a significant biochemical response. Mean creatine kinase levels during IVIG therapy decreased significantly before the fourth IVIG perfusion (P < 0.01). Side effects, usually minor, were noted in 6 patients. This benefit allowed the initial prednisone dose to be reduced by >50% in all patients. The mean (+/- SD) followup time for the 25 patients who responded favorably to IVIG treatment was 51.4 +/- 13.1 months. Twelve of these 25 patients remained in full remission following their initial course of IVIG, resulting in complete stoppage of medication in 5 patients or low doses of steroids in 7 patients. The condition of 6 patients remained improved and no other drugs were prescribed, but the patients remained dependent on IVIG infusions. Seven of the 25 patients who responded well to IVIG treatment relapsed at an average of 17.1 months (range 4-23 months) after the discontinuation of IVIG. CONCLUSION:
IVIG is an interesting therapy for the treatment of polymyositis, with results showing that the condition of approximately 70% of the patients tested improved. After the discontinuation of the IVIG therapy, the efficacy remained stable in 50% of the patients, with a followup of over 3 years.
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Authors | Patrick Cherin, S Pelletier, A Teixeira, P Laforet, T Genereau, A Simon, T Maisonobe, B Eymard, S Herson |
Journal | Arthritis and rheumatism
(Arthritis Rheum)
Vol. 46
Issue 2
Pg. 467-74
(Feb 2002)
ISSN: 0004-3591 [Print] United States |
PMID | 11840450
(Publication Type: Clinical Trial, Journal Article)
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Chemical References |
- Immunoglobulins, Intravenous
- Creatine Kinase
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Topics |
- Adult
- Chronic Disease
- Creatine Kinase
(blood)
- Esophageal Diseases
(immunology, therapy)
- Female
- Follow-Up Studies
- Humans
- Immunoglobulins, Intravenous
(administration & dosage, adverse effects)
- Male
- Middle Aged
- Muscle, Skeletal
(physiology)
- Polymyositis
(immunology, therapy)
- Prospective Studies
- Recurrence
- Treatment Outcome
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