title: Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis.
abstract: BACKGROUND
  Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial.
  
  
  METHODS
  We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels.
  
  
  RESULTS
  We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = -1.02, 95% confidence interval [CI] = -2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI -0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity.
  
  
  CONCLUSIONS
  The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.
authors.affiliation: Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. hyh0103@gmail.com.
authors.forename: Yao-Hsien
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. 10462@s.tmu.edu.tw.|Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. 10462@s.tmu.edu.tw.
authors.forename: Hung-Chou
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, College of Medicine, Taipei Medical University, Taipei, Taiwan. kwhuang3@gmail.com.|Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. kwhuang3@gmail.com.|Department of Gastroenterology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. kwhuang3@gmail.com.
authors.forename: Kuang-Wei
authors.initials: KW
authors.lastname: Huang
authors.affiliation: Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. euphemus2003@msn.com.|College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. euphemus2003@msn.com.
authors.forename: Po-Chih
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. chaurjongh@tmu.edu.tw.|Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan. chaurjongh@tmu.edu.tw.
authors.forename: Chaur-Jong
authors.initials: CJ
authors.lastname: Hu
authors.affiliation: Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. chingpiaotsai@gmail.com.|Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. chingpiaotsai@gmail.com.
authors.forename: Chin-Piao
authors.initials: CP
authors.lastname: Tsai
authors.affiliation: Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. kelvintam@h.tmu.edu.tw.|Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. kelvintam@h.tmu.edu.tw.|Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. kelvintam@h.tmu.edu.tw.|Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan. kelvintam@h.tmu.edu.tw.|Center for Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. kelvintam@h.tmu.edu.tw.|Taipei Medical University-Shuang Ho Hospital, 291 Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. kelvintam@h.tmu.edu.tw.
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Tam
authors.affiliation: Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. yckuang2@gmail.com.|Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. yckuang2@gmail.com.|Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan. yckuang2@gmail.com.|Taipei Medical University-Shuang Ho Hospital, 291 Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. yckuang2@gmail.com.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Kuan
mesh_terms: D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D053580:Muscle Strength; D018908:Muscle Weakness / Q000188:drug therapy* / Q000209:etiology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D016262:Postpoliomyelitis Syndrome / Q000150:complications / Q000188:drug therapy*; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors