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A study of 20 SLE patients with intravenous immunoglobulin clinical and serologic response

Yaniv Sherer

Department of Medicine 'B' and the Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Tel-Aviv University, Israel

Alaa Ahmed

Speciality Laboratory, Santa Monica, CA, USA

Pnina Langevitz

Rheumatology Service, Sheba Medical Center, Israel

Jacob George

Department of Medicine 'B' and the Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Tel-Aviv University, Israel

Fabrizio Fabbrizzi

Jeff Terryberry

Speciality Laboratory, Santa Monica, CA, USA

Martyna Meissner

Department of Connective Tissue Diseases, Institute of Rheumatology, Warsaw, Poland

Margalit Lorber

Rambam Medical Center, Haifa, Israel

James B Peter

Speciality Laboratory, Santa Monica, CA, USA

Yehuda Shoenfeld

Department of Medicine 'B' and the Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, and Tel-Aviv University, Israel; Shoenfel{at}post.tau.ac.il

Objective: To test the clinical response of systemic lupus erythematosus (SLE) patients to intravenous immunoglobulins (IVIg), and whether the clinical response of IVIg treatment in SLE is accompanied by modification of SLE-associated autoantibodies/antibodies (Abs) and complement levels.

Methods: Twenty SLE patients were treated with high-dose (2 g/kg) IVIg monthly, in a 5-d schedule. Each patient received between 1-8 treatment courses. They were evaluated for the clinical response, Systemic Lupus Activity Measure (SLAM) score before and after IVIg, levels of antinuclear antibody (ANA), dsDNA (double-stranded DNA), SS-A or SS-B, ENA (extractable nuclear antigens), C₃ and C₄ levels before and after the treatment, and before and after each treatment course.

Results: A beneficial clinical response following IVIg treatment was noted in 17 out of 20 patients (85%). Few clinical manifestations responded more to treatment: arthritis, fever, thrombocytopenia, and neuropsychiatric lupus. In 9 patients evaluated before and after IVIg, mean SLAM score decreased from 19.3 ± 4.7 to 4 ± 2.9 (P < 0.0001). There was a tendency towards abnormal levels of complement and Abs before IVIg courses among the treatment responders compared with the non-responders, and similarly the former tended to have normalization of their abnormal levels more than the latter. These differences were found statistically significant only with respect to C₄ and SS-A or SS-B levels before IVIg courses.

Conclusion: IVIg has a high response rate among SLE patients. A combination of clinical manifestations, Abs and complement levels may aid in the future in predicting who among SLE patients will benefit more from IVIg treatment.

Key Words: autoantibodies • idiotypes • intravenous immunoglobulin • systemic lupus erythematosus

Lupus, Vol. 8, No. 9, 705-712 (1999)
DOI: 10.1191/096120399678841007


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