Use of intravenous immunoglobulin for treatment of neurologic conditions: a systematic review.
BACKGROUND
Given the increasing use of intravenous immunoglobulin (IVIG) for various neurologic conditions and uncertainty pertaining to its benefits and harms, a systematic review was conducted of randomized controlled trials (RCTs) evaluating IVIG for all neurologic indications for which there was at least one published trial.


METHODS
For this systematic review, a systematic search strategy was applied to MEDLINE (1966-June 2003) and the Cochrane Register of Controlled Trials (June 2003) to identify potentially eligible RCTs comparing IVIG to placebo or an active control. All dosage regimens were considered. Abstracts were excluded, and no restriction was placed on language of publication. Two investigators independently performed data extraction with a standardized form. Measures of effect were calculated for each trial independently, and studies were pooled based on clinical and methodologic judgment as to its appropriateness. Where pooling of trials was inappropriate, a qualitative discussion of findings is provided.


CONCLUSIONS
Thirty-seven trials representing 14 conditions were identified. IVIG is more effective than placebo for treatment of relapsing-remitting multiple sclerosis and idiopathic chronic inflammatory demyelinating polyneuropathy. There is also potential benefit for treatment of multifocal motor neuropathy, myasthenia gravis, dermatomyositis, stiff-person syndrome, and Lambert-Eaton myasthenic syndrome. There was insufficient evidence to determine whether IVIG therapy was more effective than plasma exchange for Guillain-Barré syndrome. There was also insufficient evidence regarding paraprotein-associated polyneuropathy. No evidence of benefit was observed for secondary progressive multiple sclerosis or inclusion body myositis.
Fergusson
Dean
D
Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada. dafergusson@ohri.ca
Hutton
Brian
B
Sharma
Michael
M
Tinmouth
Alan
A
Wilson
Kumanan
K
Cameron
D William
DW
Hebert
Paul C
PC
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D020274:Autoimmune Diseases of the Nervous System / Q000276:immunology / Q000628:therapy; D018592:Cross-Over Studies; D004185:Disability Evaluation; D020275:Guillain-Barre Syndrome / Q000276:immunology / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007163:Immunosorbent Techniques; D009103:Multiple Sclerosis / Q000276:immunology / Q000628:therapy; D009157:Myasthenia Gravis / Q000276:immunology / Q000628:therapy; D009422:Nervous System Diseases / Q000276:immunology / Q000628:therapy*; D010266:Paraproteins / Q000276:immunology; D010951:Plasma Exchange; D011115:Polyneuropathies / Q000276:immunology / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D010266:Paraproteins