İnflamatuvar Romatizmal Hastalıklarda İntravenöz İmmünoglobulin G (İVİG) Kullanımı: Tek Merkez Deneyimi

Yıl 2023, , 155 - 160, 08.09.2023

Salim Mısırcı , Ali Ekin , Belkıs Nihan Coşkun , Burcu Yağız , Yavuz Pehlivan , Hüseyin Ediz Dalkılıç

https://doi.org/10.32708/uutfd.1284806

Öz

İntravenöz immünoglobulin G (İVİG) tedavisi verdiğimiz inflamatuvar romatizmal hastalık (İRH) tanılı hastaların özelliklerini, organ tutulumlarını ve verdiğimiz İVİG tedavisinin özelliklerini değerlendirmeyi amaçladık. Üçüncü basamak romatoloji kliniğinde İRH tanısıyla takip edilen, Ocak 2014-Aralık 2022 tarihleri arasında en az 1 defa İVİG tedavisi almış, >18 yaş hastalar, hastane kayıt sisteminden restrospektif olarak tarandı. Çalışmaya dahil edilen toplam 33 hastanın %81,8'i (n=27) kadındı. Ortalama yaş 44.5±14.8 olarak saptandı. En sık İVİG tedavisi kullanılan hastalık grupları sistemik lupus eritematozus (SLE) (n=13, %39,4), idiyopatik inflamatuar miyopatiler (İİM) (n=8, %24,2) ve anti-nötrofil sitoplazmik antikor (ANCA) ilişkili vaskülitti (n=6, %18,2). İVİG tedavisi endikasyonu oluşturan en sık nedenler ise hematolojik tutulum (n= 9, %27,3) ve proksimal dirençli kas zayıflığıydı (n=8, %24,2). Sadece 2 (%6,1) hastada yan etki gelişmişti. Hastaların %48,5 (n=16)’inde kısmi yanıt, %27,3 (n=9)’ünde de tam yanıt mevcuttu. İVİG tedavisi sonrası metotreksat, azatiopürin ve siklofosfamid kullanımında azalma mevcutken (sırasıyla p değerleri=0.022, 0.04, 0.03), rituksimab kullanımında ise istatistiksel olarak anlamlı farklılık olmamakla birlikte artış mevcuttu. İVİG tedavisi, İRH hastalarında özellikle SLE, İİM ve ANCA ilişkili vaskülit gibi hastalıkların seyrindeki dirençli tutulumlarda güvenli bir tedavi olarak görünmektedir.

Anahtar Kelimeler

dermatomiyozit, inflamatuvar romatizmal hastalık, intravenöz immünoglobulin, polimiyozit, sistemik lupus eritematozus

Intravenous Immunoglobulin G (IVIG) Use in Inflammatory Rheumatic Diseases: A Single Center Experience

Öz

We aimed to evaluate the characteristics of patients with inflammatory rheumatic disease (IRD) who received intravenous immunoglobulin G (IVIG) treatment, their organ involvement, and the characteristics of the IVIG treatment we gave. Patients aged >18 years who were followed up in a tertiary rheumatology clinic with a diagnosis of IRD, who received at least 1 course of IVIG treatment between January 2014 and December 2022, were reviewed restrospectively from the hospital registration system. Of the 33 patients included in the study, 81.8% (n=27) were female. The mean age was 44.5±14.8 years. The most common disease groups for which IVIG therapy was used were systemic lupus erythematosus (SLE) (n=13, 39.4%), idiopathic inflammatory myopathies (IIM) (n=8, 24.2%) and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (n=6, 18.2%). The most common causes of IVIG treatment indication were hematological involvement (n= 9, 27.3%) and proximal resistant muscle weakness (n=8, 24.2%). Only 2 (6.1%) patients developed side effects. Partial response was observed in 48.5% (n=16) and complete response in 27.3% (n=9) of the patients. There was a decrease in the use of methotrexate, azathiopurine and cyclophosphamide after IVIG treatment (p values=0.022, 0.04, 0.03, respectively), while there was an increase in rituximab use, although there was no statistically significant difference. IVIG treatment seems to be a safe treatment in IRH patients, especially in refractory involvement in the course of diseases such as SLE, IIM and ANCA-associated vasculitis.

Anahtar Kelimeler

dermatomyositis, inflammatory rheumatic disease, intravenous immunoglobulin, polymyositis, systemic lupus erythematosus

Kaynakça

• 1. Mulhearn B, Bruce IN. Indications for IVIG in rheumatic diseases. Rheumatology (Oxford). 2015;54(3):383-391. doi:10.1093/rheumatology/keu429
• 2. Gandiga PC, Ghetie D, Anderson E, Aggrawal R. Intravenous Immunoglobulin in Idiopathic Inflammatory Myopathies: a Practical Guide for Clinical Use [published online ahead of print, 2023 Jun 1]. Curr Rheumatol Rep. 2023;10.1007/s11926-023-01105-w. doi:10.1007/s11926-023-01105-w.
• 3. Perez EE, Orange JS, Bonilla F, et al. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol. 2017;139(3S):S1-S46. doi:10.1016/j.jaci.2016.09.023
• 4. Ky C, Swasdibutra B, Khademi S, Desai S, Laquer V, Grando SA. Efficacy of Intravenous Immunoglobulin Monotherapy in Patients with Cutaneous Lupus Erythematosus: Results of Proof-of-Concept Study. Dermatol Reports. 2015;7(1):5804. Published 2015 Mar 16. doi:10.4081/dr.2015.5804
• 5. Trucco SM, Jaeggi E, Cuneo B, et al. Use of intravenous gamma globulin and corticosteroids in the treatment of maternal autoantibody-mediated cardiomyopathy. J Am Coll Cardiol. 2011;57(6):715-723. doi:10.1016/j.jacc.2010.09.044
• 6. McGrath ER, Doughty CT, Amato AA. Autoimmune Myopathies: Updates on Evaluation and Treatment. Neurotherapeutics. 2018;15(4):976-994. doi:10.1007/s13311-018-00676-2
• 7. Levy Y, Sherer Y, Ahmed A, et al. A study of 20 SLE patients with intravenous immunoglobulin--clinical and serologic response. Lupus. 1999;8(9):705-712. doi:10.1191/096120399678841007
• 8. Goodfield M, Davison K, Bowden K. Intravenous immunoglobulin (IVIg) for therapy-resistant cutaneous lupus erythematosus (LE). J Dermatolog Treat. 2004;15(1):46-50. doi:10.1080/09541440042000269
• 9. Camara I, Sciascia S, Simoes J, et al. Treatment with intravenous immunoglobulins in systemic lupus erythematosus: a series of 52 patients from a single centre. Clin Exp Rheumatol. 2014;32(1):41-47.
• 10. Dalakas MC, Illa I, Dambrosia JM, et al. A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med. 1993;329(27):1993-2000. doi:10.1056/NEJM199312303292704
• 11. Cherin P, Pelletier S, Teixeira A, et al. Results and long-term followup of intravenous immunoglobulin infusions in chronic, refractory polymyositis: an open study with thirty-five adult patients. Arthritis Rheum. 2002;46(2):467-474. doi:10.1002/art.10053
• 12. Miyasaka N, Hara M, Koike T, et al. Effects of intravenous immunoglobulin therapy in Japanese patients with polymyositis and dermatomyositis resistant to corticosteroids: a randomized double-blind placebo-controlled trial. Mod Rheumatol. 2012;22(3):382-393. doi:10.1007/s10165-011-0534-4
• 13. Aggarwal R, Charles-Schoeman C, Schessl J, Dimachkie MM, Beckmann I, Levine T. Prospective, double-blind, randomized, placebo-controlled phase III study evaluating efficacy and safety of octagam 10% in patients with dermatomyositis ("ProDERM Study"). Medicine (Baltimore). 2021;100(1):e23677. doi:10.1097/MD.0000000000023677
• 14. https://www.fda.gov/media/150814/download
• 15. Lapraik C, Watts R, Bacon P, et al. BSR and BHPR guidelines for the management of adults with ANCA associated vasculitis. Rheumatology (Oxford). 2007;46(10):1615-1616. doi:10.1093/ rheumatology/kem146a
• 16. Crickx E, Machelart I, Lazaro E, et al. Intravenous Immunoglobulin as an Immunomodulating Agent in Antineutrophil Cytoplasmic Antibody-Associated Vasculitides: A French Nationwide Study of Ninety-Two Patients. Arthritis Rheumatol. 2016;68(3):702-712. doi:10.1002/art.39472
• 17. Armağan B, Farisoğulları B, Oral H, et al. Evaluation of Intravenous Immunoglobulin G treatment in Outpatients Rheumatology Practice. Acta Medica, (2021), 52(4), 348–355. https://doi.org/10.32552/2021.ActaMedica.707)
• 18. Wang DX, Shu XM, Tian XL, et al. Intravenous immunoglobulin therapy in adult patients with polymyositis/dermatomyositis: a systematic literature review. Clin Rheumatol. 2012;31(5):801-806. doi:10.1007/s10067-012-1940-5
• 19. Brennan VM, Salomé-Bentley NJ, Chapel HM. Immunology Nurses Study. Prospective audit of adverse reactions occurring in 459 primary antibody-deficient patients receiving intravenous immunoglobulin. Clin Exp Immunol. 2003;133(2):247-251. doi:10.1046/j.1365-2249.2003.02199