IVIG Monotherapy Mediates Improvement in CLE

A single-center proof-of-concept study was conducted to learn whether intravenous immunoglobulin (IVIG) can control acute cutaneous lupus erythematosus (CLE) and thus replace current systemic immunosuppressive therapy that causes severe side effects and adverse reactions. IVIG was administered to 16 patients who tried and failed various systemic treatments for CLE at 500 mg/kg/day on four consecutive days, up to a total of 2 g/kg/month for three months. The subjects were monitored for a possible relapse for an additional six months without any drug treatment.

Cumulative results revealed an overall improvement in both objective and subjective measures of disease activity. The CLE Disease Area and Severity Index (CLASI-A) score dropped from a baseline defined as 100 percent, and remained in the range of approximately 70 percent until the last visit. Three patients had a temporary flare of CLE symptoms, but recovered within a month from the relapse. There were no serious side effects or adverse events. The investigators concluded that IVIG monotherapy for CLE was associated with 1) a rapid and persistent decrease in disease activity, 2) steady improvement in patients’ quality of life assessed by Skindex-29 scores, 3) a low relapse rate, and 4) relapses that were mild and of short duration. As healing was maintained for months after IVIG treatment, the investigators also raised the possibility that “IVIG triggered molecular events … that continued to unfold after the end of therapy.”