Immunoglobulin - Info & Q? (long)
Stacy Lovdahl
Thanks for all the posts regarding Steroids(synaptic misfire)! The Neuro
wants to give SM IVIg - IV immunoglobulin 1mg/Kg body weight. We don't know
much about this - Anyone out there that can give us your experience we'd
really appreciate it. The info we've read seems to vary - the studies are
all small and some show benefit and some don't.... Every thing is a little
old - 1998. Has anyone had this? Does it have side effects? What should
we be asking?
THANKS!!!
Stacy
From WebMd & a quick search, we understand that it's:
ImmunoGlobulin - A group of GlycoProteins (AntiBodies), present in Serum and
tissue fluids that recognize and bind to Antigens. They are produced by
Plasma Cells and are integral in Adaptive Immune Responses. There are five
classes of ImmunoGlobulins (Ig): IgG, IgA, IgM, IgD, IgE. #22, #25
http://text.nlm.nih.gov/nih/cdc/www/80txt.html Several small studies have
shown positive responses to IVIG in the majority of treated patients who
have Chronic Inflammatory Demyelinating Polyneuropathies. Treatment needs to
be periodically repeated to prevent relapse. When considered in comparison
with customary treatments, IVIG may be easier to use and associated with
fewer complications than repeated therapeutic plasma exchange and long-term
glucocorticoids, respectively.
http://www1.kingston.net/~msking/research.htm IMMUNOGLOBULIN SHOWS NO
BENEFIT FOR REMYELINATION:
Currently there are no treatments available to improve a stable deficit in
multiple sclerosis. It had been previously shown in animal studies that
intravenous immunoglobulins could help central nervous system remyelination.
This new study conducted by Dr. M.Stangel and others at the University of
Berlin sought to find if these results could be shown using a double-blind
placebo controlled approach on human MS patients with a stable clinical
deficit...disability. The clinical improvement using immunoglobulin was so
slight that it was deemed negligible. In conclusion, the resulting data does
not support a role for immunoglobulin in treating MS. Source: J. Neurol
Neurosurg Psychiatry 2000, Jan, 68 (1): 89-92
Combined ImmunoGlobulin & Azathioprine In Relapsing/Remitting Multiple
Sclerosis
Kalanie H, Tabatabai SS
Eur Neurol 1998;39(3):178-81
Shahid Beheshti University of Medical Sciences,
Mehr Hospital,
Department of Neurology,
Tehran, Iran
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PMID # 9605396, UI # 98266433
Abstract
In an attempt to prevent exacerbations of Multiple Sclerosis, ImmunoGlobulin
therapy was combined with Azathioprine (AZA).
IntraVenous ImmunoGlobulin (I.V.IG) 2 g/kg was given in divided doses over 3
consecutive days followed by monthly booster doses (0.2 g/kg) for 3 years to
38 patients with Relapsing/Remitting Multiple Sclerosis (MS).
In the 34 patients who completed the trial, the relapse rate decreased (from
1.7 relapses per year to 0 during the 3-year trial period).
The Kurtzke Expanded Disability Status Scale decreased from 3.4 +/- 0.72 to
3.0 +/- 0.70. The results suggest that combined I.V.IG and AZA suppress the
ongoing pathologic process in Relapsing/Remitting MS.
IntraVenous ImmunoGlobulin Reduces MRI Activity In Relapsing Multiple
Sclerosis
Sorensen PS, Wanscher B, Jensen CV, Schreiber K, Blinkenberg M, Ravnborg M,
Kirsmeier H, Larsen VA, Lee ML
Neurology 1998 May;50(5):1273-81
Copenhagen University Hospital,
Department of Neurology,
Rigshospitalet, Denmark
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PMID # 9595974, UI # 98255413
Abstract
We wanted to assess whether IntraVenous ImmunoGlobulin G (IVIG) decreases
disease activity on MRI in Relapsing MS. Previous trials of IVIG in
Relapsing/Remitting MS demonstrated a reduction of acute relapses, but these
studies did not include MRI.
We treated 26 patients in a randomized, double-blind, crossover study of
IVIG 1 g/kg daily or placebo on 2 consecutive days every month during two
6-month treatment periods. The primary end point was the number of
Gadolinium-enhancing lesions on monthly serial MRI.
Secondary efficacy variables were the occurrence of exacerbations, clinical
Neurologic ratings, total MS lesion load on T2-weighted MRI, and multimodal
Evoked Potentials. Eighteen patients completed the entire trial; eight
patients did not.
Twenty-one patients completed the first treatment period and at least two
MRI examinations in the second treatment period and were included in the
intention-to-treat analysis.
On serial MRI, we observed fewer enhancing lesions per patient per scan
during IVIG treatment (median, 0.4; range, 0 to 9.3) than during placebo
treatment (median, 1.3; range, 0.2 to 25.7; p = 0.03).
During IVIG treatment, 15 patients were exacerbation free compared with only
7 on placebo (p = 0.02). The total number of exacerbations in the IVIG
period was 11 and in the placebo period, 19 (not significant). None of the
remaining secondary efficacy measures were significantly different between
the two treatment periods.
The number of adverse events, in particular Eczema, was significantly higher
during IVIG therapy than during placebo treatment. These results suggest
that IVIG treatment is beneficial to patients with Relapsing MS.
Failure of IntraVenous ImmunoGlobulin To Arrest Progression Of Multiple
Sclerosis
A clinical and MRI based study
Francis GS, Freedman MS, Antel JP
Mult Scler 1997 Dec;3(6):370-6
Montreal Neurological Institute,
Department of Neurology and Neurosurgery,
Quebec, Canada
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PMID # 9493636, UI # 98152630
Abstract
Due to the modest benefit, inconvenience and high cost of currently
available therapies for MS, it is appropriate to seek alternative
treatments. Based on anecdotal evidence suggestive of benefit for I.V.IG in
MS, we conducted an open-label, unblinded protocol of I.V.IG in nine MS
patients.
The patients were given induction doses of I.V.IG followed by monthly
boosters for 1 year and had clinical, MRI and CSF analyses performed.
Patients included were both progressive and Relapsing.
There was no clinical benefit nor apparent MRI benefit utilizing this
protocol. During treatment the majority of patients continued to progress or
have attacks and MRI demonstrated continued accumulation of T2-weighted
lesions. CSF was unaffected by treatment.
IntraVenous ImmunoGlobulin therapy: Effects Of Acute And Chronic Treatment
In Multiple Sclerosis
Sorensen PS
Mult Scler 1996 Jul;1(6):349-52
National University Hospital,
Copenhagen Multiple Sclerosis Clinic,
Department of Neurology,
Denmark
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PMID # 9345416, UI # 98005276
Abstract
High dose IntraVenous ImmunoGlobulin (IVIG) exerts several effects on the
Immune System that could have a beneficial influence on the disease
processes in Multiple Sclerosis (MS).
IVIG may be useful in treatment of acute exacerbations, in prevention of new
relapses, and in promotion of ReMyelination. Presently, the clinical
evidence of effect of IVIG in MS is based on the results of small open
trials, some of which, however, have been encouraging.
Confirmation of a beneficial effect of IVIG must await the results of
placebo-controlled, double-blind trials currently ongoing in several
centers. If effective, IVIG administration would be a valuable supplement to
the existing treatment of MS.
IVIG Treatment For Primary Or Secondary Progressive Multiple Sclerosis
Outline of a double-blind randomized, placebo-controlled trial.
Poehlau D, Federlein J, Postert T, Sailer M, Bethke F, Kappos L, Haas J,
Przuntek H
Mult Scler 1997 Apr;3(2):149-52
Neurologische Uniklinik der Ruhr-Universitat Bochum am St. Josef Hospital,
Germany
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PMID # 9291171, UI # 97434948
Abstract
We present the design of a double-blind, randomised placebo-controlled phase
III study to evaluate safety and efficacy of IVIG in the treatment of
patients suffering from Primary or Secondary Chronic Progressive Multiple
Sclerosis.
The primary endpoint is disability. Two measures of disability were chosen
in order to assess the primary end point
Sustained improvement (assessed at month 6, confirmed at month 9)
Progression to increasing disability of the disease (sustained for 3 months)
at any time during the course of this 2 years study.
The disability is measured by the Expanded Disability Status Scale (EDSS).
Secondary end points include the assessment of Visual function, functions of
the Upper Extremity, Cognitive functions, Depression and Quality of Life.
Trial Of IV ImmunoGlobulin In Multiple Sclerosis
Preliminary results
Sorensen PS, Wanscher B, Schreiber K, Blinkenberg M, Jensen CV, Ravnborg M
Mult Scler 1997 Apr;3(2):145-8
Rigshospitalet and The Danish Magnetic Resonance Center,
Copenhagen University Hospital,
Copenhagen Multiple Sclerosis Clinic, Department of Neurology,
Denmark
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PMID # 9291170, UI # 97434947
Abstract
We enrolled 25 patients with Relapsing/Remitting or Relapsing/Progressive
Multiple Sclerosis (MS) in a randomized placebo-controlled double-blind
study of IntraVenous ImmunoGlobulin (IVIG). IVIG 1 g/kg daily for 2 days was
administered every 4 weeks for 24 weeks.
Seventeen patients completed the whole trial, whereas eight patients
discontinued the trial; four during IVIG treatment and four on placebo. Of
the 17 patients who completed the trial, 11 had no exacerbations during IVIG
treatment compared with only six on placebo (P=O.05).
The total number of exacerbations in the IVIG period was 11 and in the
placebo period 15 (NS), and the number of severe exacerbations requiring
treatment with IntraVenous MethylPrednisolone was four during treatment with
IVIG and six on placebo (NS).
The results suggest that IVIG treatment may be of benefit for prevention of
exacerbations in patients with Relapsing MS.
Treatment Effects Of Monthly IntraVenous ImmunoGlobulin In R/R Multiple
Sclerosis
Further Analyses Of The Austrian ImmunoGlobulin In MS Study
Fazekas F, Deisenhammer F, Strasser-Fuchs S, Nahler G, Mamoli B
Mult Scler 1997 Apr;3(2):137-41
Karl-Franzens University,
Department of Neurology,
Graz, Austria
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PMID # 9291168, UI # 97434945
Abstract
Recently, the Austrian ImmunoGlobulin in Multiple Sclerosis (AIMS) study
showed patients with Relapsing/Remitting Multiple Sclerosis to benefit from
repeated administration of IntraVenous ImmunoGlobulin (IVIg).
To provide a more detailed understanding of IVIg's action we performed
further analyses on the time course of treatment effects and in regard to
the impact of clinical disability at study entry on patients' response to
medication.
The AIMS trial was a randomized, placebo-controlled, double blind,
multicenter trial. It included 148 patients (IVIg: 75; placebo 73) who
suffered from Relapsing/Remitting MS, were 15-65 years old and scored from
1-6 on the Expanded Disability Status Scale (EDSS).
IVIg was given over 2 years in a monthly dosage of 0.15-0.2 g/kg body weight
Within the first 6 months of the trial clinical disability of IVIg treated
patients improved significantly from a baseline EDSS of 3.33 +/- 1.38 to a
score of 3.05 +/- 1.73 (P=0.002).
This improvement was retained over the subsequent 18 months of the trial
(final EDSS: 3.09 +/- 1.62). In contrast, placebo-treated patients showed a
slight trend for deterioration over the study period (baseline EDSS: 3.37
+/- 1.67; final EDSS: 3.49 +/- 1.83).
IVIg treatment was associated with a significant reduction of relapses
throughout the study which was independent of the patients' disability at
baseline.
The observation of clinical improvement in the early phase of IVIg
medication may suggest the activation of repair mechanisms such as the
promotion of ReMyelination while ImmunoRegulatory effects would be expected
as the cause of fewer exacerbations throughout the AIMS study.
These hypotheses need to be tested in future trials.
Promotion Of Endogenous ReMyelination In Multiple Sclerosis
Lucchinetti CF, Noseworthy JH, Rodriguez M
Mult Scler 1997 Apr;3(2):71-5
Mayo Clinic Foundation,
Department of Neurology,
Rochester, Minnesota, USA
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PMID # 9291156, UI # 97434933
Abstract
Studies in both human and experimental models demonstrate that Myelin repair
occurs in the Central Nervous System and is a normal physiologic response to
Myelin injury. However, ReMyelination in MS is often incomplete and limited.
The outcome of an actively DeMyelinating lesion depends on the balance
between factors promoting Myelin destruction and Myelin repair.
Experimental models of CNS DeMyelination provide an opportunity to
investigate the Morphologic, Cellular and Molecular mechanisms involved in
ReMyelination.
This review focuses on experiments using the Theiler's virus model of
DeMyelination which indicate that manipulation of the Immune Response has
the potential to promote endogenous CNS ReMyelination and functional
recovery in MS.
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Lemmoncake
There was an Argentinian member of the alt.support-mult.sclerosis USENET group
awhile back who had experience if iv Ig. I believe his name is Horacio
Fernandez. Perhaps he still reads this NG, 'tho maybe not regularly. You could
try Dixie's ASMS website for his email addy.
Jayne
Ericam2
only thing that cured my double vision.
I strongly recommend a 2-thronged approach, non-gluten diet and some type of
drug beit IVIG or one of the ABC's
Erica MM
Stacy Lovdahl
fatigue started out slow last fall and became "mind numbing". They gave him
steroids in Dec '00 and again in Feb '01 for double vision, and a bunch of
other symptoms. I guess fatigue is not an exacerbation all by itself? The
last round of steroids left him very wiped out. He had a couple extremely
bad days right after the last dose of the "taper". So the Neuro said he
should have immunoglobulin. He's going in next Wed. But today and
yesterday he feels good. Good! :-) I can't smile enough about that.
So, are there side effects of immunoglobulin? The nurse who drew his blood
for a screening test said it's called liquid gold cuz it costs $10,000 a
dose. Is that true? Is it a substitute for ABCs or a supplement?
I know these are alot of questions, but we're completely in the dark!
Thank you so much,
Stacy
"Ericam2" <eri...@aol.com> wrote in message
news:20010308124722...@ng-fw1.aol.com...
Ericam2
I have not had any side effects on the immunoglobulin.
Erica MM