Intravenous immunoglobulin application following immunoadsorption: benefit or risk in patients with autoimmune diseases?

Author(s): Schmaldienst S, Mullner M, Goldammer A, Spitzauer S, Banyai S, Horl WH, Derfler K

Affiliation(s): Department of Medicine III, Division of Nephrology and Dialysis, University of Vienna, Wahringer Gurtel 18-20, 1090 Vienna, Austria.

Publication date & source: 2001-05, Rheumatology (Oxford)., 40(5):513-21.

Publication type: Clinical Trial; Randomized Controlled Trial

OBJECTIVE: To evaluate infection rates, side-effects and autoantibody resynthesis after immunoadsorption with and without intravenous immunoglobulin substitution. METHODS: Thirty-five patients with autoimmune diseases who were on long-term immunoadsorption therapy participated in a prospective, randomized study. Results and conclusions. Infections were rare but similar in frequency in patients receiving combined immunoadsorption and intravenous immunoglobulins (intervention group, n=17, 1.3 infections per patient-year) and in a control group (n=18, 0.9 infections per patient-year) treated by immunoadsorption alone. The reduction in IgG achieved with two immunoadsorptions within 3 days was 95.0+/-2.5%. The extent of removal of pathogenic autoantibodies was similar to the removal of IGG: Substitution of immunoglobulins was not associated with an increased circulating IgG level before the following immunoadsorption. Infusion of immunoglobulins at a dose of 0.14 g/kg (interquartile range 0.12-0.16) body weight in patients in whom circulating immunoglobulins had been depleted was associated with a high incidence of serious side-effects; these necessitated the termination of treatment in 24% of the patients. No evidence was found that immunoglobulin administration had any beneficial effect with respect to autoantibody resynthesis after immunoadsorption.