Intravenous immunoglobulin application following immunoadsorption: benefit or risk in patients with autoimmune diseases?
OBJECTIVE
To evaluate infection rates, side-effects and autoantibody resynthesis after immunoadsorption with and without intravenous immunoglobulin substitution.


METHODS
Thirty-five patients with autoimmune diseases who were on long-term immunoadsorption therapy participated in a prospective, randomized study. Results and conclusions. Infections were rare but similar in frequency in patients receiving combined immunoadsorption and intravenous immunoglobulins (intervention group, n=17, 1.3 infections per patient-year) and in a control group (n=18, 0.9 infections per patient-year) treated by immunoadsorption alone. The reduction in IgG achieved with two immunoadsorptions within 3 days was 95.0+/-2.5%. The extent of removal of pathogenic autoantibodies was similar to the removal of IGG: Substitution of immunoglobulins was not associated with an increased circulating IgG level before the following immunoadsorption. Infusion of immunoglobulins at a dose of 0.14 g/kg (interquartile range 0.12-0.16) body weight in patients in whom circulating immunoglobulins had been depleted was associated with a high incidence of serious side-effects; these necessitated the termination of treatment in 24% of the patients. No evidence was found that immunoglobulin administration had any beneficial effect with respect to autoantibody resynthesis after immunoadsorption.
Schmaldienst
S
S
Department of Medicine III, Division of Nephrology and Dialysis, University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Müllner
M
M
Goldammer
A
A
Spitzauer
S
S
Banyai
S
S
Hörl
W H
WH
Derfler
K
K
D000328:Adult; D001323:Autoantibodies / Q000096:biosynthesis; D001327:Autoimmune Diseases / Q000276:immunology / Q000628:therapy*; D001781:Blood Component Removal; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects*; D007163:Immunosorbent Techniques; D007239:Infections / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D001323:Autoantibodies; D016756:Immunoglobulins, Intravenous