Efficacy of Subcutaneous and Intravenous Immunoglobulin in Patients with Multifocal Motor Neuropathy: A Systematic Review and Meta-analysis.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Annals of Indian Academy of Neurology Pub Date : 2025-04-04 DOI:10.4103/aian.aian_815_24

Indar Kumar Sharawat, Pragnya Panda, Lesa Dawman, Ananthanarayanan Kasinathan, Prateek Kumar Panda

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引用次数: 0

Abstract

Background and objectives: Multifocal motor neuropathy (MMN) is an uncommon chronic autoimmune disorder in adults. Several randomized and non-randomized studies with small sample sizes have shown promising results with subcutaneous immunoglobulin (SCIg) in MMN patients who have a stable disease course with intravenous immunoglobulin (IVIg). This systematic review aimed to compare the efficacy of SCIg and IVIg treatment in MMN patients in terms of changes in muscle power, grip strength, motor function, disability, quality of life, as well as adverse effects.

Methods: Random- or fixed-effect model was used, as appropriate, to determine the pooled weighted estimates for outcome variables, depending on the degree of heterogeneity. A total of 11 publications from nine studies (110 patients, mean age 54.3 ± 3.4 years, 57% males, duration of illness 9.7 ± 2.4 years) were included in the review.

Results: Changes in the Medical Research Council sum score (MRC-SS), grip strength, dexterity, and disability due to neuropathy following IVIg and SCIg administration were comparable (P = 0.30, I² = 9%; P = 0.51, I² = 0%; P = 0.45, I² = 0%; and P = 0.57, I² = 0%, respectively). Changes in health-related quality of life were numerically better with SCIg, although the difference did not reach statistical significance (P = 0.17, I² = 72%,). Over the long term, there was a trend toward fewer disease fluctuations compared to IVIg (P = 0.43), and the efficacy comparable to IVIg was maintained in terms of muscle strength, disability, and quality of life parameters (P = 0.83, 0.85, and 0.59, respectively). The incidence of moderate to severe systemic adverse effects was significantly lower with SCIg infusion compared to previous years when patients received IVIg (P = 0.03).

Conclusions: SCIg can be considered an acceptable alternative to IVIg in patients with MMN, with a better safety profile.

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皮下注射和静脉注射免疫球蛋白治疗多灶性运动神经病的疗效：一项系统综述和荟萃分析。

背景和目的：多灶性运动神经病（MMN）是一种罕见的成人慢性自身免疫性疾病。一些随机和非随机的小样本研究显示，皮下免疫球蛋白（SCIg）对静脉注射免疫球蛋白（IVIg）病程稳定的MMN患者有很好的效果。本系统综述旨在比较SCIg和IVIg治疗MMN患者在肌肉力量、握力、运动功能、残疾、生活质量以及不良反应方面的疗效。方法：根据异质性的程度，酌情使用随机或固定效应模型来确定结果变量的合并加权估计。共纳入9项研究的11篇文献（110例患者，平均年龄54.3±3.4岁，57%为男性，病程9.7±2.4年）。结果：IVIg和SCIg给药后，医学研究委员会总评分（MRC-SS）、握力、灵活性和因神经病变导致的残疾的变化具有可比性(P = 0.30, I²= 9%；P = 0.51, i²= 0%；P = 0.45, i²= 0%；P = 0.57, I²= 0%)。SCIg在健康相关生活质量方面的变化在数值上更好，尽管差异没有达到统计学意义（P = 0.17, I²= 72%）。从长期来看，与IVIg相比，疾病波动趋势更少（P = 0.43），并且在肌肉力量，残疾和生活质量参数方面保持与IVIg相当的疗效（P分别= 0.83,0.85和0.59）。与前几年接受IVIg的患者相比，SCIg输注中重度全身不良反应的发生率显著降低（P = 0.03）。结论：对于MMN患者，SCIg可以被认为是IVIg的可接受替代方案，具有更好的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Indian Academy of Neurology Nervous System Diseases-

CiteScore

2.20

自引率

11.80%

发文量

293

审稿时长

29 weeks

期刊介绍： The journal has a clinical foundation and has been utilized most by clinical neurologists for improving the practice of neurology. While the focus is on neurology in India, the journal publishes manuscripts of high value from all parts of the world. Journal publishes reviews of various types, original articles, short communications, interesting images and case reports. The journal respects the scientific submission of its authors and believes in following an expeditious double-blind peer review process and endeavors to complete the review process within scheduled time frame. A significant effort from the author and the journal perhaps enables to strike an equilibrium to meet the professional expectations of the peers in the world of scientific publication. AIAN believes in safeguarding the privacy rights of human subjects. In order to comply with it, the journal instructs all authors when uploading the manuscript to also add the ethical clearance (human/animals)/ informed consent of subject in the manuscript. This applies to the study/case report that involves animal/human subjects/human specimens e.g. extracted tooth part/soft tissue for biopsy/in vitro analysis.