[Long-term treatment with i.v. immunoglobulin in the therapy of systemic lupus erythematosus].
BACKGROUND
Treatment of several autoimmune diseases with intravenous gammaglobulins (IvIg) has been demonstrated to be safe and effective in determining clinical improvement and decreasing autoantibody titer. We tested the hypothesis that IvIg would be effective in patients with Systemic Lupus Erythematosus (SLE).


METHODS
We conducted an open trial involving 12 patients with SLE refractory to conventional treatments with monthly infusion of IvIg at a dosage of 400 mg/kg/day for 5 consecutive days. The duration of the therapy with the same dose every 4 weeks was from 16 to 24 months.


RESULTS
A progressive clinical improvement was observed in 11 patients during IvIg therapy, and it persisted during the all period of treatment. The clinical improvement was associated with an increase of haemoglobin, albumin levels, total serum complement and C3 and C4 components, platelets count in 2 thrombocytopenic patients, and a progressive reduction of ESR, plasma immunocomplexes and antinuclear antibodies. A marked improvement in serum urea, creatinine clearance and proteinuria was also observed in the patients with renal involvement. We have not observed any adverse effects with the long-term use of this treatment. Several mechanisms have been postulated to explain the effect of IVIg in the treatment of autoimmune diseases. Many experimental and clinical data support the interesting hypothesis that IVIg may be effective in some autoimmune diseases by restoring a normal function or the physiological immune network through the same regulatory mechanisms leading to a suppression of autoimmune disorders in normal individuals. The presence of a wide spectrum of anti-idiotypic antibodies in IVIg could regulate T and B-cell activities preventing the emergence of B-cell clones with specificity for autoantigens epitopes and down-regulating autoantibodies production.


CONCLUSIONS
The results obtained suggest that IvIg therapy seems to be a promising and beneficial approach in the treatment of SLE. However, double-blind studies are necessary to confirm the results obtained particularly to ascertain the optimal dosage, the schedule of infusion and the duration of maintenance therapy with IVIg, and to determine their long-term effectiveness, the reduction in late morbidity and mortality and the effect on the quality of life of patients with SLE. Moreover, because of the high cost of IVIg, their use seems to be especially indicated for patients non responders to conventional treatments and for these with infectious complications.
Francioni
C
C
Istituto di Reumatologia, Università, Siena.
Fioravanti
A
A
Gelli
R
R
Megale
F
F
Marcolongo
R
R
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D013997:Time Factors
D016756:Immunoglobulins, Intravenous
Trattamento a lungo termine con immunoglobulina e.v. nel terapia del lupus eritematoso sistemico.