Experimental study on the use of intravenous immunoglobulin (IVIg) in patients with steroid-resistant Crohn's disease.
BACKGROUND
Treatment of Crohn's disease is based on anti-inflammatory and immunosuppressive therapy. Over time, however, approx. 20 % of patients develop steroid resistance. In these cases, alternative treatment methods are required. Short-term application of intravenous immunoglobulin (IVIg) may serve as an additional alternative.


METHODS
In 19 steroid-resistant patients (case collection over 15 years) suffering from Crohn's disease (mean CDAI 284.1 +/- 149.8), IVIg therapy with Venimmun, Gamimmun, Octagam, respectively (7 days 10 g/day i. v.) or Sandoglobin (total dose: 72 g or 90 g i. v., respectively, over a period of 8 or 10 days) was applied in addition to basic medication (5-ASA/SASP plus corticosteroids). CDAI according to Best was assessed on a weekly basis starting 3 weeks prior to and ending 4 weeks after completion of therapy. 8 patients could be followed for a longer period.


RESULTS
All patients benefited from this treatment and the effectiveness of IVIg therapy could not only be observed during therapy, but also during the four consecutive weeks after therapy. At 4 weeks after therapy, a total of 14 patients (73.7%) reached a clinical remission (CDAI < 150) and 14 patients (73.7%) showed a CDAI decrease of > 100 points. In the 8 patients who could be followed over a longer period of time, a mean remission duration of 20.6 months was observed. Apart from a slight rise in temperature in one patient, no significant side effects occurred.


CONCLUSIONS
In patients suffering from Crohn's disease, IVIg therapy may be applied effectively and with few side effects, however, not as remission maintenance, but as a stopgap treatment during an acute attack with steroid resistance, e. g., until therapy with other immunosuppressive agents becomes effective. To validate our presented results, a prospective, randomised, placebo-controlled trial has to be proposed.
Chrissafidou
A
A
Marienhospital Bottrop, Abteilung für Innere Medizin, Bottrop, Germany. achrissaf@web.de
Malek
M
M
Musch
E
E
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; C021306:IgG, sulfonated; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; C495669:Octagam