Combined high-dose intravenous immunoglobulin in the management of severe systemic lupus erythematosus / 中华皮肤科杂志

ABSTRACT

Objective To investigate the efficacy of combined high-dose intravenous immunoglobulin (IVIG) pulse therapy in patients with severe systemic lupus erythematosus (SLE). Methods Thirty-six patients were enrolled into this study, and randomly classified into WIG group (n=17) and methylprednisolone (MP) group (n=19). The treatment of patients in MG group began with a 3-day intravenous MP followed by intravenous WIG 400 mg per kilogram of body weight per day for 3-5 days, then was switched to oral prcdnisone and cyclophosphamide at routine dose. Intravenous MG was given repeatedly with an interval of 1 month for 2-5 sessions. Patients in MP group were treated with the same corticosteroids and immunosuppressants as used in WIG group but without IVIG. Patients were followed up for 3-12 months.The clinical efficacy, related serum parameters, and systemic lupus activity measurement (SLAM) were evaluated and compared between the two groups. Results Most patients in both groups showed a remission of symptoms and reduction in disease activity after treatment. The decrease in SLAM, positivity rates of antinuclear antibodies and anti-double-stranded DNA (anti-dsDNA) antibodies as well as the increase in platelets were faster in IVIG group than those in MP group (all P<0.05), but the long-term efficacy of the two groups was similar (P>0.05). Infections occurred in 11.8% of patients in WIG group and 36.8% of patients in MP group. Conclusions High-dose intravenous immunoglobulin may serve as an effective aid in the treatment of severe SLE, and is particularly beneficial to patients resistant to corticosteroids and immunosuppressants of routine dose and those accompanied by severe infections and intolerable to high dose of corticosteroids and immunosuppressants.