Intravenous Immunoglobulin in Idiopathic Inflammatory Myopathies: a Practical Guide for Clinical Use.

IF 5.7 2区医学 Q1 RHEUMATOLOGY

Current Rheumatology Reports Pub Date : 2023-08-01 DOI:10.1007/s11926-023-01105-w

Prateek C Gandiga, Daniela Ghetie, Elizabeth Anderson, Rohit Aggrawal

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引用次数: 0

Abstract

Purpose of review: Idiopathic inflammatory myopathies (IIM) are a complex family of autoimmune systemic disorders which often affect muscle and/or skin. IIM cause significant morbidity and mortality, but optimal treatment is uncertain. This review provides a practical guide for using intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG) in the management of IIM, including dermatomyositis (DM), polymyositis (PM), immune-mediated necrotizing myositis (IMNM), and spontaneous inclusion body myositis (IBM), based on relevant recent literature and experience. We summarize pertinent considerations when using IVIG in special circumstances, including myositis-related dysphagia, interstitial lung disease (ILD), calcinosis cutis, and pregnant patients. This review also discusses IVIG safety, available formulations, and costs.

Recent findings: While IVIG has been used de facto for severe IIM for over 30 years, prior clinical trials of IVIG were notably limited. Recently, however, IVIG has proven safe and effective against IIM in several high-impact publications, including a large prospective, randomized placebo-controlled phase III study in DM. IVIG is useful against both muscular and extra-muscular manifestations in many types of IIM. It can be used as a first-line, steroid-sparring agent or as add-on to other treatments, tailored to specific clinical IIM scenarios. It is generally well-tolerated and has good safety profile, but accessibility and cost still limit its use.

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静脉注射免疫球蛋白治疗特发性炎性肌病:临床使用实用指南。

综述目的:特发性炎症性肌病(IIM)是一种复杂的自身免疫系统疾病家族，通常影响肌肉和/或皮肤。IIM引起显著的发病率和死亡率，但最佳治疗尚不确定。本文综述了静脉注射免疫球蛋白(IVIG)和皮下免疫球蛋白(SCIG)在IIM治疗中的应用，包括皮肌炎(DM)、多发性肌炎(PM)、免疫介导坏死性肌炎(IMNM)和自发性包涵体肌炎(IBM)，基于近期相关文献和经验。我们总结了在特殊情况下使用IVIG的相关考虑，包括肌炎相关的吞咽困难，间质性肺疾病(ILD)，皮肤钙质沉着症和孕妇。本综述还讨论了IVIG的安全性、可用的配方和成本。最近的研究发现:虽然IVIG实际上已经用于治疗严重IIM超过30年，但IVIG之前的临床试验明显有限。然而，最近在一些高影响力的出版物中，IVIG已被证明对IIM是安全有效的，包括一项大型前瞻性、随机安慰剂对照的糖尿病III期研究。IVIG对许多类型IIM的肌肉和肌肉外表现都是有用的。它可以作为一线的类固醇辅助剂，也可以作为其他治疗的补充，根据特定的临床IIM情况量身定制。它通常耐受性好，安全性好，但可及性和成本仍然限制其使用。

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

Current Rheumatology Reports RHEUMATOLOGY-

CiteScore

11.20

自引率

0.00%

发文量

期刊介绍： This journal aims to review the most important, recently published research in the field of rheumatology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of rheumatologic conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas such as the many forms of arthritis, osteoporosis and metabolic bone disease, and systemic lupus erythematosus. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also occasionally provided.