Intravenous immunoglobulin therapy in multiple sclerosis

D.V. Maltsev, C.K. Yevtushenko


Despite the promising findings of fundamental researches, evidence base of clinical application of i/v immunoglobulin (IVIG) in multiple sclerosis (MS) is still quite shaky and uncertain. Based on the results of studies conducted before 2008, EFNS experts recommended IVIG as the treatment of the second or even third line in patients with relapsing-remitting MS, if the other recommended drugs are not tolerated or did not give the desired clinical effect. However, concept of effectiveness and safety of i/v immunoglobulin in MS recently expanded and entrenched. A recent meta-analysis of randomized controlled trials (n = 537), provided by Olyaeemanesh A. et al., have shown that IVIG use significantly increases the number of patients without relapses and number of improvements, and reduces the incidence of deterioration of the clinical status in MS patients compared to placebo. These findings should confirm the IVIG position as a second line strategy in relapsing-remitting MS. When selecting immunotherapy, you should take into account the additional information, which may indicate potential benefits of an immunoglobulin, including immune status, in particular, the presence of humoral immunodeficiency, peripheral nervous system involvement in the pathological process, the presence of opportunistic infections or autoimmune reactions as a complication of immunosuppressive treatment and pregnancy status. Although IVIG is not the first and not the main therapeutic strategy in MS, this safe and effective immunomodulatory agent can be indispensable in some patients with MS, who do not meet in a proper way the recommended first line therapeutic interventions.


multiple sclerosis; immunotherapy; i/v immunoglobulin


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