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Cajamarca-Barón J, Buitrago-Bohórquez J, Orozco JEM, Segura O, Guavita-Navarro D, Gallego-Cardona L, Cubides H, Arredondo AM, Escobar A, Rojas-Villarraga A. Efficacy and safety of intravenous immunoglobulin in patients with lupus nephritis: A systematic review of the literature. Clin Exp Rheumatol 2022; 21:103182. [PMID: 36028194 DOI: 10.1016/j.autrev.2022.103182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVE Intravenous immunoglobulin (IVIg) is an anti-inflammatory drug with an unclear role in the treatment of patients with lupus nephritis (LN). This systematic review evaluates the evidence for IVIg in the care of patients with LN. METHODOLOGY A systematic search was done in the PubMed, EMBASE, BVS and OVID databases - All EBM Reviews following the PRISMA methodology (registration in PROSPERO CRD42021236662). The variables were extracted: indications for use, dosage, partial or complete response, adverse reactions, initiation of renal replacement therapy, reduction of proteinuria, and mortality. The quality assessment was done with the "The Joanna Briggs Institute (JBI) Critical Appraisal tools for use in Systematic Reviews Checklist". In addition, synthesis reports were prepared through the Synthesis Without Meta-analysis - SWiM guide. RESULTS A total of 2328 articles were obtained (28 were considered for inclusion). When the studies were evaluated, IVIg therapy was found to be between 60% to 70% effective (except for patients with class V LN) with overall responses (complete + partial) even for patients who are refractory to first line treatment. Normalization (<0.5 g) of nephrotic proteinuria occurred in 24% of cases with infrequent adverse events and a mortality plus dialysis composite of 11.5% and 24.1% (most representative study). CONCLUSION In patients with LN refractory to conventional treatment or co-infection situations, the reported data seem to demonstrate effectiveness of IVIg therapy. There are few adverse reactions and caution is exercised when using it on patients with class V NL. However, given the lack of controlled studies with long-term follow-up, these data should be interpreted cautiously thus encouraging the development of high-quality RCTs.
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Affiliation(s)
- Jairo Cajamarca-Barón
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Cra 19 No. 8A - 32, 111411 Bogotá, Colombia.
| | - Jhon Buitrago-Bohórquez
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Cra 19 No. 8A - 32, 111411 Bogotá, Colombia
| | - José Emmanuel Mendoza Orozco
- Internal Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia, Cra 19 No. 8A - 32, 111411 Bogotá, Colombia.
| | - Omar Segura
- Research Institute, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia, Cra 19 No. 8A - 32, 111411 Bogotá, Colombia.
| | - Diana Guavita-Navarro
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Cra 19 No. 8A - 32, 111411 Bogotá, Colombia
| | - Laura Gallego-Cardona
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Cra 19 No. 8A - 32, 111411 Bogotá, Colombia
| | - Hector Cubides
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Cra 19 No. 8A - 32, 111411 Bogotá, Colombia
| | - Ana María Arredondo
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Cra 19 No. 8A - 32, 111411 Bogotá, Colombia
| | - Alejandro Escobar
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Cra 19 No. 8A - 32, 111411 Bogotá, Colombia
| | - Adriana Rojas-Villarraga
- Research Institute, Fundación Universitaria de Ciencias de la Salud (FUCS), Cra 19 No. 8A - 32, 111411 Bogotá, Colombia.
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Perez EE, Orange JS, Bonilla F, Chinen J, Chinn IK, Dorsey M, El-Gamal Y, Harville TO, Hossny E, Mazer B, Nelson R, Secord E, Jordan SC, Stiehm ER, Vo AA, Ballow M. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol 2016; 139:S1-S46. [PMID: 28041678 DOI: 10.1016/j.jaci.2016.09.023] [Citation(s) in RCA: 368] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 09/12/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
Abstract
Human immunoglobulin preparations for intravenous or subcutaneous administration are the cornerstone of treatment in patients with primary immunodeficiency diseases affecting the humoral immune system. Intravenous preparations have a number of important uses in the treatment of other diseases in humans as well, some for which acceptable treatment alternatives do not exist. We provide an update of the evidence-based guideline on immunoglobulin therapy, last published in 2006. Given the potential risks and inherent scarcity of human immunoglobulin, careful consideration of its indications and administration is warranted.
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Affiliation(s)
- Elena E Perez
- Allergy Associates of the Palm Beaches, North Palm Beach, Fla.
| | - Jordan S Orange
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Francisco Bonilla
- Department of Pediatrics, Clinical Immunology Program, Children's Hospital Boston and Harvard Medical School, Boston, Mass
| | - Javier Chinen
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Ivan K Chinn
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Morna Dorsey
- Department of Pediatrics, Allergy, Immunology and BMT Division, Benioff Children's Hospital and University of California, San Francisco, Calif
| | - Yehia El-Gamal
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Terry O Harville
- Departments of Pathology and Laboratory Services and Pediatrics, University of Arkansas, Little Rock, Ark
| | - Elham Hossny
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Bruce Mazer
- Department of Pediatrics, Allergy and Immunology, Montreal Children's Hospital and McGill University, Montreal, Quebec, Canada
| | - Robert Nelson
- Department of Medicine and Pediatrics, Division of Hematology and Oncology and Stem Cell Transplantation, Riley Hospital, Indiana University School of Medicine and the IU Melvin and Bren Simon Cancer Center, Indianapolis, Ind
| | - Elizabeth Secord
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, Mich
| | - Stanley C Jordan
- Nephrology & Transplant Immunology, Kidney Transplant Program, David Geffen School of Medicine at UCLA and Cedars-Sinai Medical Center, Los Angeles, Calif
| | - E Richard Stiehm
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | - Ashley A Vo
- Transplant Immunotherapy Program, Comprehensive Transplant Center, Kidney Transplant Program, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Mark Ballow
- Department of Pediatrics, Division of Allergy & Immunology, University of South Florida, Morsani College of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla
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3
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Popkov VA, Plotnikov EY, Silachev DN, Zorova LD, Pevzner IB, Jankauskas SS, Zorov SD, Babenko VA, Zorov DB. Diseases and Aging: Gender Matters. BIOCHEMISTRY (MOSCOW) 2016; 80:1560-70. [PMID: 26638680 DOI: 10.1134/s0006297915120032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
At first glance, biological differences between male and female sex seem obvious, but, in fact, they affect a vast number of deeper levels apart from reproductive function and related physiological features. Such differences affect all organizational levels including features of cell physiology and even functioning of separate organelles, which, among other things, account for such global processes as resistance to diseases and aging. Understanding of mechanisms underlying resistance of one of the sexes to pathological processes and aging will allow taking into consideration gender differences while developing drugs and therapeutic approaches, and it will provide an opportunity to reproduce and enhance such resistance in the more vulnerable gender. Here we review physiological as well as cellular and biological features of disease course including aging that are affected by gender and discuss potential mechanisms behind these processes. Such mechanisms include features of oxidative metabolism and mitochondrial functioning.
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Affiliation(s)
- V A Popkov
- Lomonosov Moscow State University, Belozersky Institute of Physico-Chemical Biology, Moscow, 119991, Russia.
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4
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Sánchez-Ramón S, Valor L. [Therapy with intravenous gammaglobulins in systemic inflammatory autoimmune diseases: new indications?]. Med Clin (Barc) 2014; 143:130-3. [PMID: 24480286 DOI: 10.1016/j.medcli.2013.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/14/2013] [Accepted: 11/21/2013] [Indexed: 11/15/2022]
Affiliation(s)
| | - Lara Valor
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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5
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Abstract
Therapeutic antibodies have been used since the end of nineteenth century, but their use is progressively increased and recently, with the availability of monoclonal antibodies, they are successfully employed in a large disease spectrum, which transversally covers different fields of medicine. Hyperimmune polyclonal immune globulin has been used against infectious diseases, in a period in which anti-microbial drugs were not yet available, and it still maintains a relevant place in prophylaxis/therapy. Although immune globulin should be considered life-saving as replacement therapy in humoral immunodeficiencies, its place in the immune-modulating treatment is not usually first-choice, but it should be considered as support to standard approved treatments. Despite therapeutic monoclonal antibodies have been lastly introduced in therapy, their extreme potentiality is reflected by the large number of approved molecules, addressed toward different immunological targets and able to heavily influence the prognosis and quality of life of a wide range of different diseases.
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Affiliation(s)
- Simonetta Salemi
- Sapienza Università di Roma -Facoltà di Medicina e Psicologia , Azienda Ospedaliera S. Andrea, Roma , Italy
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Servat JJ, Mears KA, Black EH, Huang JJ. Biological agents for the treatment of uveitis. Expert Opin Biol Ther 2012; 12:311-28. [PMID: 22339439 DOI: 10.1517/14712598.2012.658366] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The conventional treatment of uveitis includes corticosteroids and immunosuppressive agents, which are highly efficacious, but can be associated with serious systemic side effects. Over the last two decades, advances in the understanding of the pathogenesis of inflammatory diseases, as well as improved biotechnology, have enabled selective targeting of the chemical mediators of diseases. Recently, a new class of drugs called biologics, that target the various mediators of the inflammation cascade, may potentially provide more effective and less toxic treatment. AREAS COVERED This article is a review and summary of the peer-reviewed evidence for biologic agents in the treatment of various forms of ocular inflammation and it focuses on the potential use of other biologic agents that have been tested in experimental autoimmune uveitis. Pubmed was used as our main tool for our literature search. Some additional references were taken from books written on the subject. EXPERT OPINION There are a wide variety of new and emerging biological agents currently being used in the treatment of uveitis which has expanded the therapeutic horizons far beyond previous limitations.
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Affiliation(s)
- Juan Javier Servat
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, 40 Temple Street, NH 06510, USA
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7
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Abstract
The intravenous administration of exogenous pooled human immunoglobulin (i.v. IG) was originally licensed as antibody replacement therapy in patients with primary immunodeficiencies and there are currently six FDA-approved uses for this agent. Despite a current lack of FDA approval, off-label treatment of a multitude of dermatologic disorders with i.v. IG has shown exciting potential for this unique treatment modality. The diseases successfully treated with i.v. IG include autoimmune bullous diseases, connective tissue diseases, vasculitides, toxic epidermal necrolysis, and infectious disorders (such as streptococcal toxic shock syndrome). Currently the biggest drawback in the consideration of i.v. IG therapy in dermatologic disorders is the lack of randomized controlled trials. Nevertheless, there is a significant body of evidence demonstrating the efficacy of i.v. IG in patients with dermatologic disorders that are resistant to treatment with standard agents. In summary, i.v. IG constitutes a valuable and potentially life-saving agent in managing patients with a variety of dermatologic disorders under the appropriate circumstances.
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Affiliation(s)
- Anthony P Fernandez
- Department of Dermatology and Cutaneous Surgery, Unversity of Miami Miller School of Medicine, Miami, Florida, USA
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8
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Abstract
Chronic intraocular inflammation (IOI) is a heterogeneous group of rare diseases, which represents one of the leading causes of acquired and treatable blindness in adults. The main anatomical site of inflammation is the uveal tract, which is the vascular organ of the eye, but uveitis is now used to describe IOI more globally. In around 40% of the cases of uveitis an underlying systemic disease, often of autoimmune origin, can be identified. In autoimmune diseases with IOI, uveitis may be the first clinical manifestation and may represent the most severe sign. Studies in animal models, especially in experimental autoimmune uveitis (EAU), offer the opportunity to investigate the pathogenicity of these disorders. The conventional treatment of IOI includes corticosteroids and immunosuppressive agents, which are efficient in around one-half of the patients, but their effectiveness is also limited by their iatrogenicity. The effects of intravenous immunoglobulins (IVIGs) on ocular inflammation have been investigated in a wide spectrum of autoimmune/systemic diseases. Most of the publications are case series or open trials. They show favorable results in a subset of indications, including mainly ocular cicatricial pemphigoid (OCP), Vogt-Koyanagi-Harada (VKH) syndrome, or birdshot disease. Efficacy results are more debated in other conditions such as inflammatory demyelinating optic neuritis. In other diseases with IOI only case reports are available, suggesting that IVIGs may be of some interest. These observations support the need for controlled trials to demonstrate the efficacy of IVIGs and assess their potential steroid-sparing effect.
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Affiliation(s)
- Zéra Tellier
- Laboratoire Français du Fractionnement et des Biotechnologies, 3 avenue des Tropiques BP 305, 91958 Courtaboeuf cedex, France.
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9
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Abstract
Ocular inflammation may affect all eye layers: conjunctiva, sclera, uvea, and orbital tissues. The main eye involvement requiring a systemic treatment is uveitis, which represents a heterogeneous group of rare diseases, most of which are sight-threatening. In around 40% of uveitis cases an underlying systemic disease, often of autoimmune origin, can be identified. In autoimmune diseases with intraocular inflammation (IOI), uveitis may be the first clinical manifestation and may represent the most severe sign. Studies in animal models, especially in experimental autoimmune uveitis (EAU), offer the opportunity to investigate the pathogenicity of these disorders. The conventional treatment of IOI includes corticosteroids and immunosuppressive agents, which are efficient in around one-half of the patients; however, their effectiveness is also limited by their iatrogenicity. The effects of intravenous immunoglobulin (IVIg) on ocular inflammation have been investigated in a wide spectrum of autoimmune/systemic diseases. Most publications are case series or open trials. They show favorable results in a subset of indications including mainly ocular cicatricial pemphigoid, Vogt-Koyanagi-Harada syndrome, or birdshot disease. Efficacy results are more debated in other conditions, such as inflammatory demyelinating optic neuritis. In other diseases with IOI (Wegener disease, Behcet's disease, inflammatory myositis), only case reports are available, suggesting that IVIg may be of some interest. These observations support the need for controlled trials to demonstrate the efficacy of IVIg and assess their potential steroid-sparing effect.
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Affiliation(s)
- Zera Tellier
- Laboratoire Francais du Fractionnement et des Biotechnologies, Les Ulis, France.
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10
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Jones J, O'Toole EA, Rustin MHA, Whittaker SJ. Case 1. Systematic lupus erythematosus (SLE). Clin Exp Dermatol 2002; 27:78-9. [PMID: 11952683 DOI: 10.1046/j.0307-6938.2001.00948.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Jones
- Department of Dermatology, Royal Free Hospital, Pond Street, London, UK.
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11
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Pu SJ, Luo SF, Wu YJ, Cheng HS, Ho HH. The clinical features and prognosis of lupus with disease onset at age 65 and older. Lupus 2000; 9:96-100. [PMID: 10787005 DOI: 10.1191/096120300678828109] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Systemic lupus erythematosus (SLE) in the elderly is uncommon and rarely reported with disease onset at age 65 and older. The aim of this study is to retrospectively analyze the influence of age at disease onset on the clinical features and prognosis of SLE. From 1988 to 1998, we encountered 21 lupus patients with disease onset at age 65 and older (all are included in group A). For comparison, 21 lupus patients with disease onset between 50-64 years of age (group B) and 152 lupus patients with disease onset before 50 years of age (group C) were obtained by a simple random sampling method from the hospital registry. Clinical features as included in the 1982 ARA revised criteria for classification of SLE and survival rate were analyzed and compared among these three groups. Group A had a smaller female to male ratio, longer duration from disease onset to diagnosis, less malar rash, more discoid lupus, and shorter survival rate that group C. There was no statistically significant difference in clinical features and survival between groups A and B, as well as between female and male patients of these two groups. The main cause of death in group A was septic shock. In conclusion, the clinical features and prognosis of SLE were influenced by the age at disease onset. However, clinical features and prognosis of SLE were similar in both late-onset lupus groups.
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Affiliation(s)
- S J Pu
- Department of Internal Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
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12
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Levy Y, Sherer Y, George J, Rovensky J, Lukac J, Rauova L, Poprac P, Langevitz P, Fabbrizzi F, Shoenfeld Y. Intravenous immunoglobulin treatment of lupus nephritis. Semin Arthritis Rheum 2000; 29:321-7. [PMID: 10805356 DOI: 10.1016/s0049-0172(00)80018-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the clinical response of treatment-resistant membranous and membranoproliferative lupus nephritis to intravenous immunoglobulin (IVIg). METHODS Seven lupus nephritis patients who failed to respond to at least prednisone and cyclophosphamide were studied. A kidney biopsy showing either membranous or membranoproliferative glomerulonephritis was available in six patients. They were treated with six courses (patients 1 and 2) or 1 or 2 courses (patients 3 through 7) of high-dose IVIg. For patients 3 through 7, the plasma levels of albumin, total cholesterol, urea, creatinine, dsDNA antibody titers, and daily proteinuria were measured just before the IVIg therapy, immediately on completion, and 6 months later. RESULTS All seven patients had a beneficial response to IVIg. In patient 1, decrease in proteinuria was evident 2 weeks after IVIg was started, nephrotic syndrome gradually disappeared, and she had no proteinuria in 3 years' follow-up. Decline in proteinuria was evident in patient 2 after the 4th IVIg course, but proteinuria reached the pretreatment level 4 months after the therapy ended. In patients 3 through 7, the mean daily proteinuria before IVIg (5.3 +/- 2.1 g) decreased after 1 or 2 IVIg courses (3.3 +/- 1.4 g), and further decreased when measured 6 months later (2.1 +/- 1.3 g). Similarly, the plasma cholesterol level decreased while the plasma albumin level increased after IVIg. CONCLUSIONS IVIg might be effective in treatment-resistant membranous or membranoproliferative lupus nephritis. Future studies should concentrate on determining the preferred treatment protocol of IVIg for the various classes of lupus nephritis.
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Affiliation(s)
- Y Levy
- Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
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Sherer Y, Langevitz P, Levy Y, Fabrizzi F, Shoenfeld Y. Treatment of chronic bilateral pleural effusions with intravenous immunoglobulin and cyclosporin. Lupus 1999; 8:324-7. [PMID: 10413213 DOI: 10.1191/096120399678847759] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 48 y old woman with unremarkable medical history was admitted with bilateral pleural effusions; even though the fluid was drained, it re-accumulated and necessitated many repeated drainages in the following 2.5 y (56 hospitalisations). The patient underwent an extensive diagnostic work-up that disclosed elevated serum antinuclear antibodies, serum anti-dsDNA antibodies, pleural fluid anti-dsDNA and decreased pleural fluid C3 and C4. During that period she has been treated with a variety of immunomodulating agents, several pleural talcage and pleurectomy, without any apparent response. Thereafter, she received six courses of IVIg (2 g/kg body weight) in monthly intervals, followed by four months treatment with cyclosporin. This treatment resulted in gradual and eventually complete disappearance of the pleural effusion, and now after more than 2 y the patient is free of symptoms and receives no further medications.
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Affiliation(s)
- Y Sherer
- Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
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Aharon A, Levy Y, Bar-Dayan Y, Afek A, Zandman-Goddard G, Skurnik Y, Fabrrizzi F, Shoenfeld Y. Successful treatment of early secondary myelofibrosis in SLE with IVIG. Lupus 1997; 6:408-11. [PMID: 9175029 DOI: 10.1177/096120339700600412] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Myelofibrosis has been reported as a rare cause of pancytopenia in patients with autoimmune diseases. We describe a 54y old female patient who was admitted with severe anemia subsequently found to be due to marrow fibrosis. During the course of her hospitalization, relying both on her clinical symptoms as well as the results of a wide range of laboratory tests and diagnostic procedures, the diagnosis of systemic lupus erythematosus was established. The patient was treated with high dose steroids, but improvement of her clinical symptoms as well as normalization of her peripheral blood count were achieved only after high dose intravenous therapy with gamma globulin (IVIG) was instituted. Along with the improvement in the peripheral blood parameters normalization of the bone marrow architecture was recorded on a repeated bone marrow biopsy. IVIG therapy should be considered in extreme cases of bone marrow suppression in SLE.
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Affiliation(s)
- A Aharon
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
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