Intravenous immunoglobulin therapy of antiphospholipid syndrome.
OBJECTIVE
To review the role of intravenous immunoglobulin (IVIg) in antiphospholipid syndrome (APS).


METHODS
A literature search was carried out for the immunopathogenesis of APS, laboratory evidence for the beneficial effect of IVIg in APS, and the clinical use of IVIg in APS.


RESULTS
There is both laboratory and clinical evidence for the beneficial role of IVIg in APS. IVIg succeeded in in vitro inhibition of anticardiolipin antibodies and lupus anticoagulant, and in the amelioration of experimental APS. Although there are few case reports about IVIg therapy in the haematological manifestations of APS, most of the reports focus on the use of IVIg in the obstetric complications of APS. Hence, in several patient series the use of IVIg either solely or in combination with aspirin/heparin resulted in successful pregnancy outcome in the vast majority of APS patients with recurrent abortions. In addition, IVIg was also beneficial in antiphospholipid antibody-positive patients undergoing in vitro fertilization.


CONCLUSIONS
APS, an autoimmune disease whose main features are vascular thrombosis and pregnancy morbidity, is a good candidate for immunotherapy with IVIg that contains anti-idiotypes directed towards patients' pathogenic antiphospholipid antibodies. Future research should determine when to use anticoagulation, IVIg or both in the treatment of APS.
Sherer
Y
Y
Department of Medicine 'B' and the Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Levy
Y
Y
Shoenfeld
Y
Y
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D017152:Antibodies, Antiphospholipid / Q000032:analysis / Q000276:immunology; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000276:immunology / Q000628:therapy*; D001241:Aspirin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D007167:Immunotherapy; D007262:Infusions, Intravenous; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D016756:Immunoglobulins, Intravenous; D006493:Heparin; D001241:Aspirin