Abstract
The effects of high-dose intravenous immunoglobulin (i.v.Ig) in 12 MG patients were studied. All patients had severe symptoms. In two cases anti-acetylcholine receptor antibodies (anti-AChR abs) were not detectable. I.V.Ig was administered to 9 patients already on long-term immunosuppressive therapy and to 3 patients at the beginning of azathioprine treatment. 10 patients (83%) improved; the duration of improvement was longer in immunosuppressed patients. Anti-AChR abs generally decreased after infusion but we did not find a constant correlation between reduction in ab titers and clinical improvement. Side effects included one case of severe hemolysis.
In our experience i.v.Ig therapy is effective in MG. The chief indication for its use appears to be the treatment of deteriotation of the disease in patients already on immunosuppressive therapy.
Sommario
Abbiamo studiato gli effetti della somministrazione di immunoglobuline (Ig) ad alto dosaggio per via endovenosa in 12 pazienti affetti da forme gravi di miastenia. Gli anticorpi anti-recettore dell'acetilcolina erano assenti in due casi. Al momento dell'infusione, 9 pazienti erano già in trattamento immunosoppressivo cronico, 3 pazienti erano in terapia con azatioprina da pochi giorni. 10 casi (83%) presentarono un evidente miglioramento clinico, la cui durata era maggiore nei pazienti in cui era già in atto un'immunosoppressione farmacologica. Dopo l'infusione di Ig, si ègeneralmente verificata una riduzione del tasso sierico di anticorpi anti-recettore; l'associazione fra questo reperto ed il miglioramento clinico non è stata, comunque, costante. Tra le complicaze, abbiamo osservato una grave emolisi.
Nella nostra esperienza l'infusione di Ig si è dimostrata una terapia efficace nella MG. Riteniamo che la sua principale indicazione riguardi il trattamento di fasi di peggioramento della malattia in pazienti già in terapia immunosoppressiva.
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Evoli, A., Palmisani, M.T., Bartoccioni, E. et al. High-dose intravenous immunoglobulin in myasthenia gravis. Ital J Neuro Sci 14, 233–237 (1993). https://doi.org/10.1007/BF02335664
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DOI: https://doi.org/10.1007/BF02335664