Critical analysis of intravenous immunoglobulin therapy for recurrent miscarriage.
Critical analysis of intravenous immunoglobulin therapy for recurrent miscarriage An alloimmune abnormality is believed to be the cause of recurrent miscarriage in couples in whom no other cause can be identified. Because of its immunosuppressive properties, intravenous immunoglobulin (IVIG) is used as a treatment for this disorder. The purpose of this study was to determine whether IVIG improves the chance of successful pregnancy in women with recurrent miscarriage by using individual patient data from efficacy trials. Detailed information on each patient enrolled in these trials was obtained to evaluate the efficacy of IVIG and investigate the effect of clinical variability on pregnancy outcome. Data from 125 patients in the IVIG group and 115 patients in the placebo group were available for analysis. Although the number of previous miscarriages and female age were both negative prognostic factors for successful outcome, there was no significant improvement in successful pregnancy or live birth rate with IVIG. Subgroup analyses indicated that timing of IVIG administration may be important. The results of the present study highlight the importance of stratification for known confounders, so that the role of IVIG can be evaluated in more detail. The collective evidence thus far indicates that IVIG does not have a therapeutic effect that is clinically meaningful.
Daya
S
S
Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada. dayas@fhs.csu.mcmaster.ca
Gunby
J
J
Porter
F
F
Scott
J
J
Clark
D A
DA
D000026:Abortion, Habitual / Q000628:therapy*; D000328:Adult; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007165:Immunosuppression Therapy; D007518:Isoantibodies / Q000276:immunology; D007694:Killer Cells, Natural / Q000276:immunology; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic
D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies