title: Improvement of intravenous immunoglobulin therapy for bullous pemphigoid by adding immunosuppressive agents: marked improvement in depletion of circulating autoantibodies.
abstract: BACKGROUND
  Various antibody-mediated autoimmune disorders are treated with intravenous immunoglobulin (IVIg). While the exact action of IVIg is unknown, it likely acts to rapidly and selectively lower the level of pathogenic antibodies. The most effective use of IVIg, an expensive and potentially toxic treatment of autoimmune disorders, remains undetermined. We propose that the addition of immunosuppressive agents to the IVIg regimen may increase the ability of IVIg to lower the level of pathogenic antibodies.
  
  
  METHODS
  For 16 months, we observed a 78-year-old patient with autoantibody-mediated bullous pemphigoid who was treated with IVIg and an adjuvant therapy on 2 separate occasions as well as IVIg alone on 2 other occasions. We observed the greatest depression of bullous pemphigoid antibodies when IVIg was combined with an immunosuppressive agent.
  
  
  CONCLUSIONS
  These results support the hypothesis that agents that suppress antibody synthesis can offset the rebound in the level of individual antibody that follows their depletion and thus can improve the effectiveness of IVIg treatment while reducing the cost and the potential toxic effects of therapy.
authors.affiliation: Department of Dermatology, New York University School of Medicine, 550 First Ave, Tisch Hospital, H313, New York, NY 10016, USA. bystryn@nyu.edu
authors.forename: Annette
authors.initials: A
authors.lastname: Czernik
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Bystryn
mesh_terms: D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010391:Pemphigoid, Bullous / Q000188:drug therapy* / Q000276:immunology*; D011241:Prednisone / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011241:Prednisone