[Intravenous administration of immunoglobulins in systemic lupus erythematosus: review of the literature and initial clinical experiences].
About 10 years ago, the first reports about the successful treatment of autoimmune thrombocytopenia with high-dose intravenously administered immunoglobulins (ivIg) were published. Since this time ivIg have been tried for treating almost any autoimmune disease. However, reports about this treatment modality are only anecdotal. So far, ivIg are a widely used and accepted treatment only for autoimmune thrombocytopenia and Kawasaki disease. During the last years many groups tried to gain a better understanding of the mechanisms by which ivIg exert their effects in autoimmune diseases. In systemic lupus erythematosus (SLE) only case reports are available which describe encouraging positive effects of ivIg especially in patients with cytopenia and vasculitis. However in some cases a serious impairment of renal function after ivIg therapy has been reported. This was seen mainly in SLE patients who already had renal involvement before ivIg therapy was started. Therefore, extreme caution should be exercised in these patients until we know more about the pathophysiology of this side effect. We have treated 6 SLE patients with high-dose ivIg (400 mg/kg, 5 days). One patient had a remission for 6 months, another patient for 36 months; in 2 patients with preexisting reduced renal function we observed two acute renal failures and in 1 patient a decrease of the renal function 1 month after ivIg treatment. These preliminary data demonstrate the necessity of controlled clinical trials to prove the effectiveness, to define indications, to find the optimal dosage, and to study the possible mechanisms of action.(ABSTRACT TRUNCATED AT 250 WORDS)
Pirner
K
K
Institut für klinische Immunologie und Rheumatologie, Friedrich-Alexander-Universität, Erlangen (BRD).
Rubbert
A
A
Burmester
G R
GR
Kalden
J R
JR
Manger
B
B
D000293:Adolescent; D000328:Adult; D000974:Antibodies, Antinuclear / Q000032:analysis; D003176:Complement C3 / Q000032:analysis; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007116:Immunization, Passive / Q000009:adverse effects; D007677:Kidney Function Tests; D008180:Lupus Erythematosus, Systemic / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged
D000974:Antibodies, Antinuclear; D003176:Complement C3; D003404:Creatinine
Intravenös verabreichte Immunoglobuline beim systemischen Lupus erythematodes: Literaturübersicht und erste klinische Erfahrungen.