title: Intravenous immunoglobulin: pharmacological properties and use in polyneuropathies.
abstract: Intravenous immunoglobulin (IVIg) is increasingly used for the treatment of autoimmune and systemic inflammatory diseases with both licensed and off-label indications. The mechanism of action is complex and not fully understood, involving the neutralization of pathological antibodies, Fc receptor blockade, complement inhibition, immunoregulation of dendritic cells, B cells and T cells and the modulation of apoptosis. Areas covered: First, this review describes the pharmacological properties of IVIg, including the composition, mechanism of action, and adverse events. The second part gives an overview of some of the immune-mediated polyneuropathies, with special focus on the pathomechanism and clinical trials assessing the efficacy of IVIg. A literature search on PubMed was performed using the terms IVIg, IVIg preparations, side effects, mechanism of action, clinical trials, GBS, CIDP. Expert opinion: Challenges associated with IVIg therapy and the treatment possibilities for immune-mediated polyneuropathies are discussed. The availability of IVIg is limited, the expenses are high, and, in several diseases, a chronic therapy is necessary to maintain the immunomodulatory effect. The better understanding of the mechanism of action of IVIg could open the possibility of the development of disease-specific, targeted immune therapies.
authors.affiliation: a Department of Neurology , University of Szeged , Szeged , Hungary.
authors.forename: Livia
authors.initials: L
authors.lastname: Dézsi
authors.affiliation: a Department of Neurology , University of Szeged , Szeged , Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Horváth
authors.affiliation: a Department of Neurology , University of Szeged , Szeged , Hungary.|b MTA-SZTE Neuroscience Research Group , Szeged , Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Vécsei
keywords: CIDP; Fc receptors; GBS; IVIg; IgG molecule; anti-ganglioside antibodies; anti-idiotype antibodies; sialylation