title: Intravenous immunoglobulins are a therapeutic option in the treatment of multiple sclerosis relapse.
abstract: OBJECTIVE
  The objective of the study is to evaluate the efficacy and tolerability of intravenous immunoglobulin (IVIG) monotherapy in the treatment of multiple sclerosis (MS) relapse.
  
  
  BACKGROUND
  High-dose intravenous methylprednisolone (IVMP) and plasmapheresis have been shown to shorten the recovery period of an MS relapse. Options for those who have contraindications for or are unresponsive to these treatments are very limited. Intravenous immunoglobulin has been used experimentally in these situations, even though there are no previous studies on its efficacy as monotherapy in MS relapse.
  
  
  METHODS
  Twelve consecutive MS patients with acute MS relapse were treated with IVIG 0.4 g/kg per day for 5 days, and the next 5 patients received IVMP 1000 mg/d for 3 days. Volumetric brain magnetic resonance imaging (MRI) and clinical evaluation using expanded disability status scale (EDSS) were performed at baseline and at 3 weeks after treatment. EDSS score after 1 year of the treatment was collected from the patient records. MRI evaluation was performed blindly but not the clinical examination and EDSS scoring.
  
  
  RESULTS
  A significant reduction in the volumes of T2-, fluid-attenuated inversion recovery-, and gadolinium-enhanced lesions was detected in the IVIG-treated group, but not in the IVMP-treated patients. The difference between the groups did not reach statistical significance. The EDSS score improved equally in both groups.
  
  
  CONCLUSIONS
  Intravenous immunoglobulin did not show inferiority compared with IVMP in the treatment of an acute MS relapse evaluated clinically and radiologically. Therefore, we suggest that IVIG may be tried as a therapy in acute MS relapse, especially in case of contraindications to IVMP and plasmapheresis.
authors.affiliation: Neuroimmunology Unit, Medical School, University of Tampere, Tampere, Finland. irina.elovaara@uta.fi
authors.forename: Irina
authors.initials: I
authors.lastname: Elovaara
authors.forename: Hanna
authors.initials: H
authors.lastname: Kuusisto
authors.forename: Xingchen
authors.initials: X
authors.lastname: Wu
authors.forename: Sanna
authors.initials: S
authors.lastname: Rinta
authors.forename: Prasun
authors.initials: P
authors.lastname: Dastidar
authors.forename: Birgit
authors.initials: B
authors.lastname: Reipert
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000628:therapy*; D010956:Plasmapheresis / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous