Intravenous immunoglobulin: new aspects of mechanism of action in chronic ITP

Author(s):  
PETER BERCHTOLD ◽  
ROBERT McMILLAN
PEDIATRICS ◽  
2003 ◽  
Vol 111 (1) ◽  
pp. 87-90
Author(s):  
Derick Holt ◽  
Justin Brown ◽  
Kelly Terrill ◽  
Robert Goldsby ◽  
Rebecka L. Meyers ◽  
...  

Objective. Response to intravenous immunoglobulin (IVIG) has been shown to predict response to splenectomy in adults with immune thrombocytopenic purpura (ITP). However, reports in children have been inconsistent. We sought to determine whether response to IVIG is predictive of response to splenectomy in children. Methods. Thirty-two assessable children were identified by a retrospective chart review. Response was graded according to previously published criteria as follows: “excellent” (platelets >150 000 within 1 week), “good” (platelets between 50 000 and 150 000), and “poor” (platelets <50 000). “Response” refers to both splenectomy and IVIG, and response to splenectomy was counted only when it was durable. Results. Twenty-one of 23 patients who had a good or excellent response to IVIG also had an excellent response to splenectomy. Six of 9 patients who had a poor response to IVIG also had a poor response to splenectomy. Response to IVIG was a sensitive predictor of response to splenectomy in 88% of patients. Response to IVIG had a specificity of 75%, a positive predictive value of 91%, and a negative predictive value of 67%. Response to prednisone and length of time to splenectomy were not correlated with splenectomy response. Conclusions. These results suggest that response to IVIG is predictive of response to splenectomy in children with chronic ITP. This correlation may be of value in deciding whether a splenectomy should be performed in children with chronic ITP.


1984 ◽  
Vol 105 (4) ◽  
pp. 676-677 ◽  
Author(s):  
Pier Angelo Tovo ◽  
Roberto Miniero ◽  
Gianna Fiandino ◽  
Paola Saracco ◽  
Maria Messina

2014 ◽  
Vol 72 (12) ◽  
pp. 966-971
Author(s):  
Paulo Victor Sgobbi de Souza ◽  
Wladimir Bocca Vieira de Rezende Pinto ◽  
Acary Souza Bulle Oliveira

During recent years, an increasing number of neuromuscular diseases have been recognized either to be caused primarily by autoimmune mechanisms, or to have important autoimmune components. The involved pathophysiological mechanisms and clinical manifestations have been better recognized and many of these disorders are potentially treatable by immunosuppression or by immunomodulation with intravenous immunoglobulin (IVIg). IVIg has been tried in a variety of immune-mediated neurological diseases, being target of widespread use in central and peripheral nervous systems diseases. Objective To give an overview of the main topics regarding the mechanism of action and different therapeutic uses of IVIg in neurological practice, mainly in neuromuscular diseases.


Blood ◽  
2005 ◽  
Vol 105 (4) ◽  
pp. 1546-1548 ◽  
Author(s):  
Seng Song ◽  
Andrew R. Crow ◽  
Vinayakumar Siragam ◽  
John Freedman ◽  
Alan H. Lazarus

AbstractThe mechanism of action of intravenous immunoglobulin (IVIg) and polyclonal anti-D–mediated reversal of immune thrombocytopenia (ITP) is still unclear. However, in a murine model of ITP, the therapeutic effect of IVIg appears to be wholly dependent upon the expression of the inhibitory Fc receptor, FcγRIIB. We previously demonstrated that, similar to anti-D in humans, 2 erythrocyte-reactive monoclonal antibodies (TER119 and M1/69) ameliorated murine ITP and inhibited reticuloendothelial system (RES) function at doses that protected against thrombocytopenia. The current study evaluated the involvement of the inhibitory and activating Fc receptors, FcγRIIB and FcγRIIIA, respectively, in the TER119 and M1/69-mediated inhibition of thrombocytopenia. In contrast to IVIg, in FcγRIIB-deficient mice, both monoclonal antibodies ameliorated ITP and both significantly down-regulated the level of expression of the activating FcγRIIIA in splenic macrophages. These results indicate that anti-erythrocyte antibodies that ameliorate ITP act independently of FcγRIIB expression but are dependent upon the activating FcγRIIIA.


Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4938-4938
Author(s):  
Soo-Mee Bang ◽  
Yeung-Chul Mun ◽  
Ho-Jin Shin ◽  
Chul Won Jung ◽  
Sung Hwa Bae ◽  
...  

Abstract This study investigated the safety and efficacy of IV-Globulin SN, a 10% intravenous immunoglobulin (IVIg), in patients with severe ITP (platelet count ¡Â20 x 109/L). Among 81 eligible patients, 31 patients were newly diagnosed, 7 patients had persistent ITP, and 43 patients had chronic ITP. Five patients had received splenectomy. Patients received IV-Globulin SN 1 g/kg/day on two consecutive days; infusion rate was initially 1 mg/kg/minute and then doubled every 30 minutes to a maximum of 8 mg/kg/minute. Fifty-eight patients (72%) attained the primary efficacy endpoint of clinical response (platelet count ¡Ã 50 x 109/L within 7 days). Their median time to response was 2 days and the median duration of response was 10 days (range from 1 to 28 days). Complete response (platelet count ¡Ã 100 x 109/L over 7 days) was obtained in 14 patients (17%). Response rates were not significantly different when compared the patients with newly diagnosed, persistent or chronic ITP; previous treatment with immunosuppressant or not; splenectomized or not. IV-Globulin SN 10% was well tolerated and the frequency of mucocutaneous bleeding was decreased during the study period (figure 1). There was no unexpected adverse event. The mean half-life and Cmax of study drug were 28.9 days and 34.6 g/L in 25 tested patients. There were no unexpected adverse events. In conclusion, IV-Globulin SN was efficacious in adult ITP patients regardless of their disease status as well as safe given that the resolution of bleeding and minimal infusion-related adverse events. (NCT02063789) Bleeding rate according the anatomic sites during the study period in 81 patients. *Visit 2 means day 1; visit 3, day 2; visit 4, day 4¡¾1; visit 5, day 6¡¾1; visit 6, day 8¡¾1, visit 7, day 11¡¾1; visit 8, day 15¡¾1; visit 9, day 22¡¾3; visit 10, day 29¡¾3) Bleeding rate according the anatomic sites during the study period in 81 patients. / *Visit 2 means day 1; visit 3, day 2; visit 4, day 4¡¾1; visit 5, day 6¡¾1; visit 6, day 8¡¾1, visit 7, day 11¡¾1; visit 8, day 15¡¾1; visit 9, day 22¡¾3; visit 10, day 29¡¾3) Disclosures Kim: Green Cross Corp.: Employment. Lee:Green Cross Corp.: Employment.


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