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SATURDAYOctober 16SESSION 18:20– 8:35Click here to return to Dermatology Update 2004 Schedule and Abstracts |
Neil H. Shear The role of intravenous immunoglobulin (IVIg) treatment for pemphigus vulgaris is not clearly established. Most protocols accept oral corticosteroids as primary therapy, often supported by steroid-sparing immunosuppressive drugs such as azathioprine, cyclophoshamide or mycophenolate mofetil. The optimal choice for treatment of resistant disease, or in situations where standard therapies cannot be tolerated or used, is not well defined. IVIg has shown promise for control of pemphigus vulgaris, as an adjunctive therapy. It is expensive (though it is currently covered by blood product programs in Canada ), and must be given in a transfusion environment. Numerous studies and a recent consensus panel suggest that IVIg is effective in the treatment of pemphigus, but no randomized, double-blinded, clinical trials have been done. IVIg is derived from pooled human serum that has been “sterilized” by ethanol precipitation, and detergents, though most recently by caprylate treatment (Gamunex, Bayer). Caprylate is a fatty acid virus inactivating agent. The final product is composed of 95% IgG monomers. The mechanism of action is not understood. The most common infusion-related side effects are headache and urticaria that are easily treated or prevented with pre-infusion treatment. The most recent treatment protocols describe dosing IVIg as 1 gram per kilogram body weight for 2 sequential days, once monthly until the disease is controlled. Serum pemphigus antibodies take about 6 months to resolve. Clinical studies, clinical practice, and apparent dose-related efficacy are intriguing, but the time is ripe for an appropriate comparative trial to establish the definitive role in therapy of a promising therapy for a devastating disease. Click here to return to Dermatology Update 2004 Schedule and Abstracts |