Immunglobulınler ve Myastenia Gravıs: Geleneksel Derleme

Yıl 2024, Cilt: 33 Sayı: 4, 280 - 286, 31.12.2024

Hilal Kaya , Zekai Halıcı

https://doi.org/10.17827/aktd.1559702

Öz

Myasthenia Gravis is an autoimmune disease characterised by the development of antibodies against proteins in the neuromuscular junction, resulting in complaints such as fatigue and muscle weakness. Quality of life is adversely affected due to complaints such as droopy eyelids (ptosis), blurred or double vision, difficulty in speaking, difficulty in swallowing and breathing. It causes morbidity and mortality due to myasthenic crisis and subsequent complications. Intravenous immunoglobulin therapy, plasmapheresis, anticholinesterase drugs, immunosuppressant drugs or thymectomy surgery can be applied in the treatment of myasthenia gravis, which can lead to serious permanent damage and rarely fatal consequences. Treatment preference varies according to the course of the disease. In this review, pharmacokinetics, administration procedures, adverse events, patient variables and cost considerations of intravenous immunoglobulin (IVIg) in myasthenia gravis will be discussed.

Anahtar Kelimeler

İntravenöz İmmunglobulin, IVIg, Myastenia Gravis

Immunoglobulıns and Myasthenia Gravis: A Traditional Rewiew

Öz

Myastenia Gravis (MG), nöromüsküler kavşaktaki proteinlere karşı antikor gelişmesi ile karakterize, yorgunluk ve kas güçsüzlükleri gibi şikayetlerle ortaya çıkan otoimmün bir hastalıktır. Göz kapağı düşüklüğü (pitoz), görmede bulanıklık veya çift görme, konuşmada güçlük, yutma ve nefes almada zorluk gibi şikayetler nedeniyle yaşam kalitesi olumsuz yönde etkilenmektedir. Miyastenik kriz ve devamında meydana gelen komplikasyonlar sebebiyle morbidite ve mortaliteye neden olmaktadır. Ciddi boyutlarda kalıcı hasarlara ve nadiren de olsa ölümcül sonuçlara yol açabilen MG hastalığının tedavisinde intravenöz immünglobulin tedavisi, plazmaferez, antikolinesteraz ilaçlar, immünosüpresan ilaçlar veya timektomi ameliyatı uygulanabilir. Tedavi tercihi hastalığın seyrine göre değişiklik gösterir. Derlememizde MG hastalığında intravenöz immünoglobulin (IVIg) uygulamasının farmakokinetik, uygulama prosedürleri, advers olaylar, hasta değişkenleri ve maliyet ile ilgili hususlar tartışılacaktır.

Anahtar Kelimeler

Intravenous immunoglobulin, myasthenia gravis, IVIg

Kaynakça

• 1. Conti-Fine BM, Milani M, Kaminski HJ. Myasthenia gravis: past, present, and future. J Clin Invest, 2006, 116: 2843-2854.
• 2. Linstrom J, Seybold M, Lennon V, Wittingham S, Drake D. Antibody to acetylcoline receptor in myasthenia gravis. Neurology, 1976, 26: 1054-1059.
• 3. Marx A, Willcox N, Leite M, Chuang W-Y, Schalke B, Nix W, Ströbel P. Thymoma and paraneoplastic myasthenia gravis. Autoimmunity, 2010, 43: 413-427.
• 4. Leite MI, Waters P, Vincent A. Diagnostic use of autoantibodies in myasthenia gravis. Autoimmunity, 2010, 43: 371-379.
• 5. Hoch W, McConville J, Helms S, Newsom-Davis J, Melms A, Vincent A. Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies. Nat Med, 2001, 7: 365-368.
• 6. Guptill JT, Sanders DB. Update on muscle-specific tyrosine kinase antibody positive myasthenia gravis. Current opinion in neurology, 2010, 23: 530-535.
• 7. Higuchi O, Hamuro J, Motomura M, Yamanashi Y. Autoantibodies to low‐density lipoprotein receptor–related protein 4 in myasthenia gravis. Ann Neurol, 2011, 69: 418-422.
• 8. Klooster R, Plomp JJ, Huijbers MG, Niks EH, Straasheijm KR, Detmers FJ, Hermans PW, Sleijpen K, Verrips A, Losen M. Muscle-specific kinase myasthenia gravis IgG4 autoantibodies cause severe neuromuscular junction dysfunction in mice. Brain, 2012, 135: 1081-1101.
• 9. Viegas S, Jacobson L, Waters P, Cossins J, Jacob S, Leite MI, Webster R, Vincent A. Passive and active immunization models of MuSK-Ab positive myasthenia: electrophysiological evidence for pre and postsynaptic defects. Exp Neurol, 2012, 234: 506-512.
• 10. Sanders D, Howard J. chap. 82: Disorders of neuromuscular transmission. Neurology in Clinical Practice, Elsevier Health Sciences, Philadelphia, 2008: 2383-2394.
• 11. Meriggioli MN. Myasthenia gravis: immunopathogenesis, diagnosis, and management. Continuum: Lifelong Learning in Neurology, 2009, 15: 35-62.
• 12. Ralph J. Bölüm 60: Genel medikal hastalıkların nöromüsküler komplikasyonları. Aminoff MJ. Neurology and general medicine, 4. Baskı 2010; 1123, 1156.
• 13. Oflazer P, Deymeer F. chap. 37: Kas ve nöromüsküler kavsak hastalıkları. Nöroloji, 2nd ed. İstanbul Üniversitesi Yayınları, İstanbul, 2011: 729-771.
• 14. Kaminski HJ, Kuks JB. Clinical Presentation and Epidemiology of Myasthenia Gravis. Myasthenia Gravis and Related Disorders, 2009: 79-94.
• 15. Tsiptsios D, Fotiou D, Haidich A, Brozou G, Nakou M, Giantselidis C, Karlovasitou A, Fotiou F. Evaluation of pupil mobility in patients with myasthenia gravis. Electromyography and clinical neurophysiology, 2008, 48: 209-218.
• 16. Ropper AH. Neurological and neurosurgical intensive care. Baskı. Lippincott Williams & Wilkins, 2004.
• 17. Putman MT, Wise RA. Myasthenia gravis and upper airway obstruction. Chest, 1996, 109: 400-404.
• 18. Chaudhuri A, Behan P. Myasthenic crisis. QJM: An International Journal of Medicine, 2009, 102: 97-107.
• 19. Rabinstein AA, Wijdicks EF In Warning signs of imminent respiratory failure in neurological patients, Seminars in neurology, (editör).^(editörler). Copyright© 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New …: 2003; 097-104.
• 20. Stetefeld HR, Schroeter M. Myasthene Krise. Fortschritte der Neurologie· Psychiatrie, 2018, 86: 301-307.
• 21. Godoy DA, Mello LJVd, Masotti L, Napoli MD. The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit. Arq Neuropsiquiatr, 2013, 71: 627-639.
• 22. Breiner A, Widdifield J, Katzberg HD, Barnett C, Bril V, Tu K. Epidemiology of myasthenia gravis in Ontario, Canada. Neuromuscular Disorders, 2016, 26: 41-46.
• 23. Keesey JC. Clinical evaluation and management of myasthenia gravis. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 2004, 29: 484-505.
• 24. Grob D, Brunner N, Namba T, Pagala M. Lifetime course of myasthenia gravis. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 2008, 37: 141-149.
• 25. Larner A. The place of the ice pack test in the diagnosis of myasthenia gravis. Int J Clin Pract, 2004, 58: 887-888.
• 26. Grubu NHÇ. Nöromuskuler Hastalıklar Tanı ve Tedavi Rehberi. Türk Nöroloji Derneği, 2007, 2: 1-53.
• 27. DEYMEER F. Myasthenia Gravis' te tedavi. Turkiye Klinikleri Journal of Internal Medical Sciences, 2005, 1: 38-43.
• 28. Alhaidar MK, Abumurad S, Soliven B, Rezania K. Current treatment of myasthenia gravis. J Clin Med, 2022, 11: 1597.
• 29. Harvey RA, Champe PC, Mycek M, Gertner S, Perper M. Lippincott's illustrated reviews: Pharmacology. Baskı. Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012.
• 30. Aljaafari D, Ishaque N. Thymectomy in myasthenia gravis: a narrative review. Saudi Journal of Medicine & Medical Sciences, 2022, 10: 97-104.
• 31. Dalakas MC. Update on intravenous immunoglobulin in neurology: modulating neuro-autoimmunity, evolving factors on efficacy and dosing and challenges on stopping chronic IVIg therapy. Neurotherapeutics, 2021, 18: 2397-2418.
• 32. Rauova L, Rovensky J, Shoenfeld Y In Immunomodulation of autoimmune diseases by high-dose intravenous immunoglobulins, Springer seminars in immunopathology, (editör).^(editörler). Springer: 2001; 447-457.
• 33. Sherer Y, Levy Y, Shoenfeld Y In Intravenous Immunoglobulin (IVIg) in Autoimmune Diseases-Expanding Indications and Increasing Specificity, Old Herborn University Seminar Monograph, (editör).^(editörler). Herborn Litterae; 1998: 2000; 85-92.
• 34. Shalem D, Shemer A, Shovman O, Shoenfeld Y, Kivity S. The efficacy of intravenous immunoglobulin in Guillain-Barré syndrome: the experience of a tertiary medical center. Isr Med Assoc J, 2018, 20: 754-760.
• 35. Watad A, Amital H, Shoenfeld Y. Intravenous immunoglobulin: a biological corticosteroid-sparing agent in some autoimmune conditions. Lupus, 2017, 26: 1015-1022.
• 36. Galeotti C, Kaveri SV, Bayry J. IVIG-mediated effector functions in autoimmune and inflammatory diseases. Int Immunol, 2017, 29: 491-498.
• 37. Figgins BS, Aitken SL, Whited LK. Optimization of intravenous immune globulin use at a comprehensive cancer center. American Journal of Health-System Pharmacy, 2019, 76: S102-S106.
• 38. Chapman J, Shoenfeld Y. Chronic inflammatory demyelinating polyradiculoneuropathy: Revisiting the role of intravenous immmunoglobulins. 2013, 15: 293-294.
• 39. Shoenfeld Y, Katz U. IVIg therapy in autoimmunity and related disorders: our experience with a large cohort of patients. Autoimmunity, 2005, 38: 123-137.
• 40. Allen JA, Gelinas DF, Freimer M, Runken MC, Wolfe GI. Immunoglobulin administration for the treatment of CIDP: IVIG or SCIG? J Neurol Sci, 2020, 408: 116497.
• 41. Levy Y, Uziel Y, Zandman G, Rotman P, Amital H, Sherer Y, Langevitz P, Goldman B, Shoenfeld Y. Response of vasculitic peripheral neuropathy to intravenous immunoglobulin. Ann N Y Acad Sci, 2005, 1051: 779-786.
• 42. Dolezal O. Intravenous immunoglobulin treatment in chronic neurological diseases: do we have maintenance dose right? Autoimmune diseases, 2014, 2014: 962530.
• 43. Bonilla FA. Pharmacokinetics of immunoglobulin administered via intravenous or subcutaneous routes. Immunology and allergy clinics of North America, 2008, 28: 803-819.
• 44. Berger M. Choices in IgG replacement therapy for primary immune deficiency diseases: subcutaneous IgG vs. intravenous IgG and selecting an optimal dose. Curr Opin Allergy Clin Immunol, 2011, 11: 532-538.
• 45. Jolles S, Orange J, Gardulf A, Stein M, Shapiro R, Borte M, Berger M. Current treatment options with immunoglobulin G for the individualization of care in patients with primary immunodeficiency disease. Clinical & Experimental Immunology, 2015, 179: 146-160.
• 46. Epstein J, Zoon K. Important drug warning: Immune Globulin Intravenous (human)(IGIV) products. Neonatal Network: NN, 2000, 19: 60-62.
• 47. Kim AS, Broide DH. Acute renal dysfunction caused by nonsucrose intravenous immunoglobulin in common variable immunodeficiency. Annals of Allergy, Asthma & Immunology, 2017, 118: 231-233.
• 48. Orbach H, Tishler M, Shoenfeld Y In Intravenous immunoglobulin and the kidney—a two-edged sword, Semin Arthritis Rheum, (editör).^(editörler). Elsevier: 2004; 593-601.
• 49. Shah S, Graeber CW. Acute renal failure following intravenous immunoglobulin therapy. Hospital Physician, 2005, 41: 29-32.
• 50. Camcıoğlu Y. İmmünoglobulin Tedavisi. Journal of Pediatric Infection/Çocuk Enfeksiyon Dergisi, 2009, 3.
• 51. Nuttall T, Malham T. Successful intravenous human immunoglobulin treatment of drug‐induced Stevens‐Johnson syndrome in a dog. Journal of small animal practice, 2004, 45: 357-361.
• 52. Oflazoğlu B, Öztürk F, Açık HK, Öncel Ç, Anadol Ü, Forta H. Nörolojik hastalıklarda IV immünglobulin tedavisinin yan etkileri. 2006.
• 53. Kol A. Human intravenous immunoglobulin (IVIG) therapy in veterinary medicine-A review. Israel Journal of Veterinary Medicine, 2008, 63: 23.
• 54. Stiehm ER. Adverse effects of human immunoglobulin therapy. Transfusion medicine reviews, 2013, 27: 171-178.
• 55. Wiendl H, Abicht A, Chan A, Della Marina A, Hagenacker T, Hekmat K, Hoffmann S, Hoffmann HS, Jander S, Keller C, Marx A, Melms A, Melzer N, Muller-Felber W, Pawlitzki M, Ruckert JC, Schneider-Gold C, Schoser B, Schreiner B, Schroeter M, Schubert B, Sieb JP, Zimprich F, Meisel A. Guideline for the management of myasthenic syndromes. Ther Adv Neurol Disord, 2023, 16: 17562864231213240.
• 56. Sanders DB, Wolfe GI, Benatar M, Evoli A, Gilhus NE, Illa I, Kuntz N, Massey JM, Melms A, Murai H. International consensus guidance for management of myasthenia gravis: executive summary. Neurology, 2016, 87: 419-425.
• 57. Skeie G, Apostolski S, Evoli A, Gilhus N, Illa I, Harms L, Hilton‐Jones D, Melms A, Verschuuren J, Horge H. Guidelines for treatment of autoimmune neuromuscular transmission disorders. European Journal of Neurology, 2010, 17: 893-902.
• 58. Estephan EP, Baima JPS, Zambon AA. Myasthenia gravis in clinical practice. Arq Neuropsiquiatr, 2022, 80: 257-265.
• 59. Sanders DB, Wolfe GI, Benatar M, Evoli A, Gilhus NE, Illa I, Kuntz N, Massey JM, Melms A, Murai H, Nicolle M, Palace J, Richman DP, Verschuuren J, Narayanaswami P. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology, 2016, 87: 419-425.
• 60. Yangın MN, Zorlu Y, Severcan F. Diagnosis and treatment methods of autoimmune myasthenia gravis: a systematic review. Aurum Journal of Health Sciences, 2022, 4: 104-116.
• 61. Wilf-Yarkoni A, Lotan I, Steiner I, Hellmann MA. Chronic low-dose intravenous immunoglobulins as steroid-sparing therapy in myasthenia gravis. J Neurol, 2021, 268: 3871-3877.
• 62. Alcantara M, Sarpong E, Barnett C, Katzberg H, Bril V. Chronic immunoglobulin maintenance therapy in myasthenia gravis. European Journal of Neurology, 2021, 28: 639-646.
• 63. Hellmann M, Mosberg-Galili R, Lotan I, Steiner I. Maintenance IVIg therapy in myasthenia gravis does not affect disease activity. J Neurol Sci, 2014, 338: 39-42.