Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity.
Intravenous immunoglobulin (IVIg) is a potential alternative treatment for anti-neutrophil cytoplasm antibody (ANCA)-associated systemic vasculitis (AASV) with less toxicity than conventional immunosuppressive agents. This randomized, placebo-controlled trial aimed to investigate the efficacy of a s...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
2000
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| _version_ | 1826301167323316224 |
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| author | Jayne, DR Chapel, H Adu, D Misbah, S O'Donoghue, D Scott, D Lockwood, C |
| author_facet | Jayne, DR Chapel, H Adu, D Misbah, S O'Donoghue, D Scott, D Lockwood, C |
| author_sort | Jayne, DR |
| collection | OXFORD |
| description | Intravenous immunoglobulin (IVIg) is a potential alternative treatment for anti-neutrophil cytoplasm antibody (ANCA)-associated systemic vasculitis (AASV) with less toxicity than conventional immunosuppressive agents. This randomized, placebo-controlled trial aimed to investigate the efficacy of a single course of IVIg (total dose 2 g/kg) in previously-treated AASV with persistent disease activity in whom there was an intention to escalate therapy. Vasculitic activity was monitored by the Birmingham vasculitis activity score (BVAS), C-reactive protein (CRP) and ANCA levels. Treatment response was defined as a reduction in BVAS of more than 50% after 3 months, and there was an intention to keep doses of concurrent immunosuppressive drugs unchanged during this period; follow-up continued to 12 months. Seventeen patients were randomized to receive IVIg and 17 to receive placebo. Treatment responses were found in 14/17 and 6/17 of the IVIg and placebo groups, respectively (p=0.015, OR 8.56, 95%CI 1.74-42.2). Following infusion of trial medication, greater falls in CRP were seen at 2 weeks (p=0.02) and 1 month (p=0.04) in the IVIg group. No differences were observed between ANCA levels or cumulative exposure to immunosuppressive drugs, and after 3 months there were no differences in CRP levels or disease activity between the IVIg and placebo groups. Seventeen adverse effects occurred after IVIg and six after placebo: they were mostly mild, although reversible rises in serum creatinine occurred in four from the IVIg group. A single course of IVIg reduced disease activity in persistent AASV, but this effect was not maintained beyond 3 months; mild, reversible side-effects following IVIg were frequent. IVIg is an alternative treatment for AASV with persistent disease activity after standard therapy. |
| first_indexed | 2024-03-07T05:28:17Z |
| format | Journal article |
| id | oxford-uuid:e14f7c5c-5f7b-469f-857d-4a8f7f825fd0 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:28:17Z |
| publishDate | 2000 |
| record_format | dspace |
| spelling | oxford-uuid:e14f7c5c-5f7b-469f-857d-4a8f7f825fd02022-03-27T09:53:35ZIntravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e14f7c5c-5f7b-469f-857d-4a8f7f825fd0EnglishSymplectic Elements at Oxford2000Jayne, DRChapel, HAdu, DMisbah, SO'Donoghue, DScott, DLockwood, CIntravenous immunoglobulin (IVIg) is a potential alternative treatment for anti-neutrophil cytoplasm antibody (ANCA)-associated systemic vasculitis (AASV) with less toxicity than conventional immunosuppressive agents. This randomized, placebo-controlled trial aimed to investigate the efficacy of a single course of IVIg (total dose 2 g/kg) in previously-treated AASV with persistent disease activity in whom there was an intention to escalate therapy. Vasculitic activity was monitored by the Birmingham vasculitis activity score (BVAS), C-reactive protein (CRP) and ANCA levels. Treatment response was defined as a reduction in BVAS of more than 50% after 3 months, and there was an intention to keep doses of concurrent immunosuppressive drugs unchanged during this period; follow-up continued to 12 months. Seventeen patients were randomized to receive IVIg and 17 to receive placebo. Treatment responses were found in 14/17 and 6/17 of the IVIg and placebo groups, respectively (p=0.015, OR 8.56, 95%CI 1.74-42.2). Following infusion of trial medication, greater falls in CRP were seen at 2 weeks (p=0.02) and 1 month (p=0.04) in the IVIg group. No differences were observed between ANCA levels or cumulative exposure to immunosuppressive drugs, and after 3 months there were no differences in CRP levels or disease activity between the IVIg and placebo groups. Seventeen adverse effects occurred after IVIg and six after placebo: they were mostly mild, although reversible rises in serum creatinine occurred in four from the IVIg group. A single course of IVIg reduced disease activity in persistent AASV, but this effect was not maintained beyond 3 months; mild, reversible side-effects following IVIg were frequent. IVIg is an alternative treatment for AASV with persistent disease activity after standard therapy. |
| spellingShingle | Jayne, DR Chapel, H Adu, D Misbah, S O'Donoghue, D Scott, D Lockwood, C Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. |
| title | Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. |
| title_full | Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. |
| title_fullStr | Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. |
| title_full_unstemmed | Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. |
| title_short | Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. |
| title_sort | intravenous immunoglobulin for anca associated systemic vasculitis with persistent disease activity |
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