Intravenous immunoglobulins for relapses of systemic vasculitides associated with antineutrophil cytoplasmic autoantibodies: results of a multicenter, prospective, open-label study of twenty-two patients.

Abstract

OBJECTIVE:

To evaluate at 9 months and 24 months the safety and efficacy of intravenous immunoglobulins (IVIGs) administered for 6 months to treat relapses of Wegener's granulomatosis (WG) or microscopic polyangiitis (MPA) occurring either under treatment or during the year following discontinuation of corticosteroids and/or immunosuppressants.

METHODS:

Patients received IVIGs (0.5 gm/kg/day for 4 days) as additional therapy administered monthly for 6 months and were assessed every 3-6 months. Corticosteroids could be maintained or reintroduced at the time of relapse; immunosuppressants could be continued but could not be reintroduced. At months 9 (end point) and 24 (followup), the following information was collected: complete or partial remission, relapse as assessed with the Birmingham Vasculitis Activity Score (BVAS) 2005, and tolerance and safety of IVIG therapy.

RESULTS:

Twenty-two Caucasian patients (7 men and 15 women) were studied: 19 had WG, and 3 had MPA. Their median age was 53 years (range 19-75 years), and their median duration of systemic vasculitis was 27 months (range 7-109 months). Their median BVAS 2005 score was 11 (range 3-25). At study entry, 21 patients were ANCA positive, and 21 patients were taking steroids and/or immunosuppressants. All patients experiencing relapse were treated with the same drug(s) plus IVIGs. All patients initially responded to IVIG therapy. By month 9, 13 patients had complete remission, 1 had partial remission, 7 had relapse, and 1 had treatment failure. In 8 of the 14 patients who had remission, the response persisted at month 24. Seven patients experienced minor side effects.

CONCLUSION:

IVIGs induced complete remissions of relapsed ANCA-associated vasculitides in 13 of 22 patients at month 9. Because of the good safety and tolerance profiles of IVIGs, these agents can be included in a therapeutic strategy with other drugs used to treat relapses of WG or MPA.

• Authors: Valérie Martinez, Pascal Cohen, Christian Pagnoux, Stéphane Vinzio, Alfred Mahr, Luc Mouthon, Laurent Sailler, Claire Delaunay, Alain Sadoun, Loïc Guillevin, French Vasculitis Study Group
• Journal: Arthritis and rheumatism (Arthritis Rheum) Vol. 58 Issue 1 Pg. 308-17 (Jan 2008) ISSN: 0004-3591 [Print] United States
• PMID: 18163506 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents
• Antibodies, Antineutrophil Cytoplasmic
• Immunoglobulins, Intravenous
• Prednisone

Topics

• Adult
• Aged
• Anti-Inflammatory Agents (therapeutic use)
• Antibodies, Antineutrophil Cytoplasmic (blood)
• Female
• Follow-Up Studies
• Granulomatosis with Polyangiitis (drug therapy, immunology)
• Humans
• Immunoglobulins, Intravenous (administration & dosage, adverse effects)
• Male
• Middle Aged
• Prednisone (therapeutic use)
• Recurrence
• Treatment Outcome