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IGIV in Neurology — Evidence and Recommendations

Published online by Cambridge University Press:  05 August 2019

Vera Bril ,
Kent Allenby ,
Gyl Midroni ,
Paul W. O'Connor  and
Jiri Vajsar
Vera Bril*
Affiliation:
Division of Neurology, The Toronto Hospital
Kent Allenby
Affiliation:
Bayer Corporation Westhaven USA
Gyl Midroni
Affiliation:
Division of Neurology, St Michael's Hospital, University of Toronto
Paul W. O'Connor
Affiliation:
Division of Neurology, St Michael's Hospital, University of Toronto
Jiri Vajsar
Affiliation:
Division of Neurology, HSC Research Institute, Hospital for Sick Children, Toronto, University of Toronto
*
Reprint requests to: Dr. Vera Bril, EN 11-209, General division, The Toronto Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4
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Abstract:

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Objective:

To summarize the evidence for neurologic uses of immunoglobulin, intravenous (IGIV) in light of present-day clinical usage. This summary guided the development of practice recommendations for the effective and efficient use of IGIV in Neurology.

Methods:

MEDLINE was searched to identify pertinent English-language review articles and original reports (n = 231) on the use of IGIV in neurology (excluding editorials, letters, and comments) published before March 1998. Evidence on alternative therapies was only included as compared to IGIV. The relevant original reports and review articles and older classic studies (n = 92) were synthesized into an information foundation. Extracted data included laboratory and clinical findings, objective measures, and clinical impressions. Clinical recommendations were based on evidence quality, graded by study design, clinical experiences of IGIV in Neurology Advisory Board members, and the conditions of IGIV use in therapy.

Results and Conclusions:

In neurology, many disorders are poorly understood, and the mechanisms behind beneficial regimens even less so. As a result, it is fairly common for best-practice decisions to rest on weaker evidence. The usefulness of IGIV in neurology can be described by a “combined score” based on evidence quality and strength of impact. Combined scores ranged from A+ (strongly recommended) to C (recommended as a last resort). The following clinical recommendations are made: IGIV is: strongly recommended for the treatment of Guillain-Barré syndrome (A+); favorably recommended for the treatment of chronic inflammatory demyelinating polyradiculoneuropathy, dermatomyositis, and multifocal motor neuropathy (A); recommended as a second resort for the treatment of multiple scerosis and myasthenia gravis (B); and recommended as a last resort for the treatment of polymyositis, inclusion-body myositis, intractable epilepsies, and stiff-man syndrome (C).

Résumé:

Résumé:But:

Nous faisons un sommaire des données en faveur de l'utilisation d'immunoglobuline intraveineuse (IGIV) en neurologie à la lumière de son utilisation actuelle en clinique. Ce sommaire a inspiré le développement de recommandations pour l'utilisation efficace de l'IGIV en neurologie.

Méthodes:

Nous avons procédé à une recherche dans MEDLINE pour identifier les articles de revue pertinents en langue anglaise et les présentations originales (n = 231) sur l'utilisation de l'IGIV en neurologie (à l'exclusion des éditoriaux, des lettres à l'éditeur et des commentaires) publiés avant mars 1998. Les données sur les traitements alternatifs ont été incluses seulement pour les comparer à l'IGIV. Les présentations originales pertinentes, les articles de revue et les études classiques plus anciennes (n = 92) ont été résumés en une fiche d'information. Les données ainsi extraites incluaient des observations cliniques et biochimiques, des mesures objectives et des impressions cliniques. Les recommandations cliniques étaient basées sur la qualité des observations, classées par plan d'étude, les expériences cliniques des membres du conseil aviseur sur l'IGIV en neurologie et les conditions d'utilisation de l'IGIV en clinique.

Résultats et conclusions:

En neurologie, plusieurs pathologies sont mal comprises et les mécanismes par lesquels certaines thérapies procurent un bénéfice le sont encore moins. Il est donc assez fréquent que la meilleure décision clinique repose sur des données faibles. L'utilité de l'IGIV en neurologie peut être présentée sous la forme d'une "cote combinée" basée sur la qualité des observations et la force de l'impact. Les cotes combinées variaient de A= (fortement recommandée) à C (recommandée en dernier recours). Nous faisons les recommandations suivantes: l'IVIG est recommandée dans le traitement de la polyradiculoneuropathie démyélinisante inflammatoire chronique, la dermatomyosite et la neuropathie motrice multifocale (A); recommandée en deuxième recours pour le traitement de la sclérose en plaques et la myasthénie grave (B); et recommandée en dernier recours pour le traitement de la polymyosite, la myosite à corps d'inclusion, les épilepsies résistantes au traitement et le syndrome de l'homme raide (C).

Type
Neurological Practice
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 2 , May 1999 , pp. 139 - 152
Copyright
Copyright © The Canadian Journal of Neurological 1999

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