Intravenous Immune Globulin Improves Systemic Sclerosis Symptoms

Administration of high-dose intravenous immune globulin (IVIG) significantly improved muscle and joint pain, muscle weakness and markers of systemic inflammation, according to a retrospective evaluation of 46 systemic sclerosis patients at 19 French centers. At baseline, the large majority of patients had muscle involvement (78 percent) and digestive tract involvement (89 percent), and about one-half had joint involvement (50 percent) and digital ulcers (52 percent). Before IVIG initiation, most patients (84 percent) had received at least one anti-inflammatory, immunosuppressive or immunomodulatory drug for a mean duration of 2.67 ± 3.65 years; regimens usually included corticosteroids (80 percent), either alone (20 percent) or combined with immunosuppressants (54 percent).

Patients received a mean 14.5 ± 18.2 IVIG cycles administered over a mean 14.8 ± 19.4 months; just over 90 percent received the usual dosage of 2.0 g/kg/cycle. In 35 percent of patients, IVIG was used as an add-on treatment without modification of other drug therapy; in the rest, background therapy was modified at IVIG initiation and/or during the IVIG course.

Improvements from start to cessation of IVIG treatment were documented in pain associated with muscle involvement (74 percent vs. 20 percent, p < 0.0001), weakness (45 percent vs. 21 percent, p = 0.01), joint pain (44 percent vs. 19 percent, p = 0.02), creatinine kinase levels (1069 ± 1552 UI vs. 288 ± 449 UI, p < 0.0001) and C-reactive protein levels (13.1 ± 17.6 mg/L vs. 9.2 ± 16.6 mg/L, p = 0.001). There were also trends for improvement of gastroesophageal reflux disease (GERD) (68 percent vs. 53 percent, p = 0.06) and bowel symptoms (42 percent vs. 27 percent, p = 0.06). Skin and cardiorespiratory involvements remained stable. The daily corticosteroid dose was also significantly lower by the end of treatment (13.0 ± 11.6 mg/day vs. 8.9 ± 10.4 mg/day, p = 0.01). The study authors also reviewed previous studies suggesting the efficacy of IVIG for various organ involvements.