nach oben

Der Nervenarzt

Erschienen in:

01.08.2009 | Übersichten

Intravenöse Immunglobuline bei Multipler Sklerose

Eine Standortbestimmung

verfasst von: Prof. Dr. S. Schwarz, H.-M. Meinck, B. Storch-Hagenlocher

Erschienen in: Der Nervenarzt | Ausgabe 8/2009

Einloggen, um Zugang zu erhalten

Zusammenfassung

Intravenöse Immunglobuline (IVIG) werden „off-label“ als Reservemedikament zur Behandlung der Multiplen Sklerose (MS) bei Kontraindikationen, Unverträglichkeiten oder unzureichender Wirkung der etablierten Therapien eingesetzt. In den letzten Jahren wurden mehrere klinische Studien zur Wirksamkeit von IVIG bei MS veröffentlicht. IVIG sind bei MS eine gut verträgliche und sichere Therapie. Schwere Nebenwirkungen sind selten. Einige Studien legen eine Wirksamkeit von IVIG bei schubförmiger MS nahe; die aktuelle PRIVIG-Studie konnte jedoch bei dieser Indikation keine positive Wirkung belegen. Vor allem für Schwangerschaft und Stillperiode erscheinen IVIG wegen der Kontraindikation für alle anderen Immuntherapeutika außer Kortison eine attraktive Alternative; allerdings gibt es zu diesem Einsatzgebiet keine aussagekräftige klinische Studie. Für andere Indikationen bei der MS liegen entweder negative Studienergebnisse vor oder die Daten sind unzureichend. Der Einsatz von IVIG als Reservemedikament bei schubförmiger MS ist möglich; die Wirksamkeit ist jedoch nicht sicher belegt. Über langfristige Effekte gibt es keine ausreichenden Informationen. Empfehlungen zur Dosierung können anhand der verfügbaren Daten nicht gegeben werden.

Achiron A, Gabbay U, Gilad R et al (1998) Intravenous immunoglobulin treatment in multiple sclerosis. Effect on relapses. Neurology 50:398–402PubMed

Achiron A, Gilad R, Margalit R et al (1994) Intravenous gammaglobulin treatment in multiple sclerosis and experimental autoimmune encephalomyelitis: delineation of usage and mode of action. J Neurol Neurosurg Psychiatry 57 [Suppl]:57–61

Achiron A, Kishner I, Dolev M et al (2004) Effect of intravenous immunoglobulin treatment on pregnancy and postpartum-related relapses in multiple sclerosis. J Neurol 251:1133–1137PubMedCrossRef

Achiron A, Kishner I, Sarova-Pinhas I et al (2004) Intravenous immunoglobulin treatment following the first demyelinating event suggestive of multiple sclerosis: a randomized, double-blind, placebo-controlled trial. Arch Neurol 61:1515–1520PubMedCrossRef

Achiron A, Pras E, Gilad R et al (1992) Open controlled therapeutic trial of intravenous immune globulin in relapsing-remitting multiple sclerosis. Arch Neurol 49:1233–1236PubMed

Achiron A, Rotstein Z, Noy S et al (1996) Intravenous immunoglobulin treatment in the prevention of childbirth-associated acute exacerbations in multiple sclerosis: a pilot study. J Neurol 243:25–28PubMedCrossRef

Diagnostik und Therapie der Multiplen Sklerose (2005) In: Diener HC (Hrsg) Leitlinien der Deutschen Gesellschaft für Neurologie. Thieme, Stuttgart

British and Dutch Multiple Sclerosis Azathioprine Trial Group (1988) Double-masked trial of azathioprine in multiple sclerosis. Lancet 2:179–183

Oxford Centre for Evidence-based Medicine Levels of Evidence (2001) Centre for Evidence-Based Medicine, University Department of Psychiatry, Warneford Hospital, Headington, Oxford, OX3 7JX, England, www.cebm.net, accessed 12.02.2008

10.

Ballow M (2007) Safety of IGIV therapy and infusion-related adverse events. Immunol Res 38:122–132PubMedCrossRef

11.

Boskovic R, Wide R, Wolpin J et al (2005) The reproductive effects of beta interferon therapy in pregnancy: a longitudinal cohort. Neurology 65:807–811PubMedCrossRef

12.

Casetta I, Iuliano G, Filippini G (2007) Azathioprine for multiple sclerosis. Cochrane Database Syst Rev:CD003982

13.

Clark DA, Coulam CB, Stricker RB (2006) Is intravenous immunoglobulins (IVIG) efficacious in early pregnancy failure? A critical review and meta-analysis for patients who fail in vitro fertilization and embryo transfer (IVF). J Assist Reprod Genet 23:1–13PubMedCrossRef

14.

Clerico M, Rivoiro C, Contessa G et al (2008) The therapy of multiple sclerosis with immune-modulating or immunosuppressive drug A critical evaluation based upon evidence based parameters and published systematic reviews. Clin Neurol Neurosurg 110(9):878–885PubMedCrossRef

15.

Confavreux C, Hutchinson M, Hours Mm et al (1998) Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in multiple sclerosis group. N Engl J Med 339:285–291PubMedCrossRef

16.

Coyle PK, Christie S, Fodor P et al (2004) Multiple sclerosis gender issues: clinical practices of women neurologists. Mult Scler 10:582–588PubMedCrossRef

17.

De Seze J, Chapelotte M, Delalande S et al (2004) Intravenous corticosteroids in the postpartum period for reduction of acute exacerbations in multiple sclerosis. Mult Scler 10:596–597CrossRef

18.

De Angelis T, Lublin F (2008) Multiple sclerosis: new treatment trials and emerging therapeutic targets. Curr Opin Neurol 21:261–271CrossRef

19.

Ellison GW, Myers LW, Mickey MR et al (1989) A placebo-controlled, randomized, double-masked, variable dosage, clinical trial of azathioprine with and without methylprednisolone in multiple sclerosis. Neurology 39:1018–1026PubMed

20.

Etemadifar M, Janghorbani M, Shaygannejad V (2007) Comparison of interferon beta products and azathioprine in the treatment of relapsing-remitting multiple sclerosis. J Neurol 254:1723–1728PubMedCrossRef

21.

Fazekas F, Deisenhammer F, Strasser-Fuchs S et al (1997) Randomised placebo-controlled trial of monthly intravenous immunoglobulin therapy in relapsing-remitting multiple sclerosis. Austrian Immunoglobulin in Multiple Sclerosis Study Group. Lancet 349:589–593PubMedCrossRef

22.

Fazekas F, Lublin FD, Li D et al (2008) Intravenous immunoglobulin in relapsing-remitting multiple sclerosis: a dose-finding trial. Neurology 71:265–271PubMedCrossRef

23.

Fazekas F, Sorensen PS, Filippi M et al (2005) MRI results from the European Study on Intravenous Immunoglobulin in Secondary Progressive Multiple Sclerosis (ESIMS). Mult Scler 11:433–440PubMedCrossRef

24.

Fergusson D, Hutton B, Sharma M et al (2005) Use of intravenous immunoglobulin for treatment of neurologic conditions: a systematic review. Transfusion 45:1640–1657PubMedCrossRef

25.

Ferrero S, Esposito F, Pretta S et al (2006) Fetal risks related to the treatment of multiple sclerosis during pregnancy and breastfeeding. Expert Rev Neurother 6:1823–1831PubMedCrossRef

26.

Ferrero S, Pretta S, Ragni N (2004) Multiple sclerosis: management issues during pregnancy. Eur J Obstet Gynecol Reprod Biol 115:3–9PubMedCrossRef

27.

Frohman EM, Brannon K, Racke MK et al (2004) Mycophenolate mofetil in multiple sclerosis. Clin Neuropharmacol 27:80–83PubMedCrossRef

28.

Gelfand EW (2006) Differences between IGIV products: impact on clinical outcome. Int Immunopharmacol 6:592–599PubMedCrossRef

29.

Ghezzi A, Di Falco M, Locatelli G (1989) Clinical controlled randomized trial of azathioprine in multiple sclerosis. In: Consette RE, Delmotte P (eds) Recent advances of multiple sclerosis therapy. Elsevier

30.

Gold R, Jawad A, Miller DH et al (2007) Expert opinion: guidelines for the use of natalizumab in multiple sclerosis patients previously treated with immunomodulating therapies. J Neuroimmunol 187:156–158PubMedCrossRef

31.

Gold R, Rieckmann P (2007) Recent advances in the pathogenesis and immunotherapy of multiple sclerosis. Nervenarzt 78 [Suppl 1]:15–225

32.

Gold R, Stangel M, Dalakas MC (2007) Drug Insight: the use of intravenous immunoglobulin in neurology-therapeutic considerations and practical issues. Nat Clin Pract Neurol 3:36–44PubMedCrossRef

33.

Goodkin DE, Bailly RC, Teetzen Ml et al (1991) The efficacy of azathioprine in relapsing-remitting multiple sclerosis. Neurology 41:20–25PubMed

34.

Gray O, Mcdonnell GV, Forbes RB (2008) Intravenous immunoglobulins for multiple sclerosis. The Cochrane Library, Vol 1

35.

Haas J (2000) High dose IVIG in the post partum period for prevention of exacerbations in MS. Mult Scler 6 [Suppl 2]:18–33

36.

Haas J, Hommes OR (2007) A dose comparison study of IVIG in postpartum relapsing-remitting multiple sclerosis. Mult Scler 13:900–908PubMedCrossRef

37.

Haas J, Maas-Enriquez M, Hartung HP (2005) Intravenous immunoglobulins in the treatment of relapsing remitting multiple sclerosis-results of a retrospective multicenter observational study over five years. Mult Scler 11:562–567PubMedCrossRef

38.

Hauser Sl, Waubant E, Arnold Dl et al (2008) B-cell depletion with rituximab in relapsing-remitting multiple sclerosis. N Engl J Med 358:676–688PubMedCrossRef

39.

Hoffmann LA, Kumpfel T, Heer I et al (2006) Pregnancy and immunomodulatory therapy in multiple sclerosis patients. Nervenarzt 77:663–670PubMedCrossRef

40.

Hommes OR, Sorensen PS, Fazekas F et al (2004) Intravenous immunoglobulin in secondary progressive multiple sclerosis: randomised placebo-controlled trial. Lancet 364:1149–1156PubMedCrossRef

41.

Humle Jorgensen S, Sorensen PS (2005) Intravenous immunoglobulin treatment of multiple sclerosis and its animal model, experimental autoimmune encephalomyelitis. J Neurol Sci 233:61–65CrossRef

42.

Jeffery DR (2004) The argument against the use of cyclophosphamide and mitoxantrone in the treatment of multiple sclerosis. J Neurol Sci 223:41–46PubMedCrossRef

43.

Kalanie H, Gharagozli K, Hemmatie A et al (2004) Interferon Beta-1a and intravenous immunoglobulin treatment for multiple sclerosis in Iran. Eur Neurol 52:202–206PubMedCrossRef

44.

Kalanie H, Tabatabai SS (1998) Combined immunoglobulin and azathioprine in multiple sclerosis. Eur Neurol 39:178–181PubMedCrossRef

45.

Katz U, Achiron A, Sherer Y et al (2007) Safety of intravenous immunoglobulin (IVIG) therapy. Autoimmun Rev 6:257–259PubMedCrossRef

46.

Katz U, Kishner I, Magalashvili D et al (2006) Long term safety of IVIg therapy in multiple sclerosis: 10 years experience. Autoimmunity 39:513–517PubMedCrossRef

47.

Kazatchkine MD, Bellon B, Kaveri SV (2000) Mechanisms of action of intravenous immunoglobulin (IVIG). Mult Scler 6 [Suppl 2]:24–33

48.

Kazatchkine MD, Kaveri SV (2001) Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med 345:747–755PubMedCrossRef

49.

Kocer B, Yildirim-Gurel S, Tali Et et al (2004) The role of qualitative and quantitative MRI assessment of multiple sclerosis lesions according to their in evaluating the efficacy of intravenous immunoglobulin G. Neuroradiology 46:287–290PubMedCrossRef

50.

La Mantia L, Milanese C, Mascoli N et al (2007) Cyclophosphamide for multiple sclerosis. Cochrane Database Syst Rev:CD002819

51.

Lewanska M, Siger-Zajdel M, Selmaj K (2002) No difference in efficacy of two different doses of intravenous immunoglobulins in MS: clinical and MRI assessment. Eur J Neurol 9:565–572PubMedCrossRef

52.

Linker Ra, Gold R (2008) Use of intravenous immunoglobulin and plasma exchange in neurological disease. Curr Opin Neurol 21:358–365PubMedCrossRef

53.

Milanese C, La Mantia L, Salmaggi A et al (1993) A double blind study on azathioprine efficacy in multiple sclerosis: final report. J Neurol 240:295–298PubMedCrossRef

54.

Morrissey SP, Le Page E, Edan G (2005) Mitoxantrone in the treatment of multiple sclerosis. Int MS J 12:74–87PubMed

55.

Nelson LM, Franklin GM, Jones MC (1988) Risk of multiple sclerosis exacerbation during pregnancy and breast-feeding. JAMA 259:3441–3443PubMedCrossRef

56.

Neuhaus O, Kieseier BC, Hartung HP (2007) Immunosuppressive agents in multiple sclerosis. Neurotherapeutics 4:654–660PubMedCrossRef

57.

Noseworthy JH, O’Brien PC, Weinshenker BG et al (2000) IV immunoglobulin does not reverse established weakness in MS. Neurology 55:1135–1143PubMed

58.

Orange JS, Hossny EM, Weiler CR et al (2006) Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol 117:525–553CrossRef

59.

Orvieto R, Achiron R, Rotstein Z et al (1999) Pregnancy and multiple sclerosis: a 2-year experience. Eur J Obstet Gynecol Reprod Biol 82:191–194PubMedCrossRef

60.

Petri M (2003) Immunosuppressive drug use in pregnancy. Autoimmunity 36:51–56PubMedCrossRef

61.

Ransohoff RM (2007) Natalizumab for multiple sclerosis. N Engl J Med 356:2622–2629PubMedCrossRef

62.

Rieckmann P, Toyka KV, Bassetti C et al (2008) Basic and escalating immunomodulatory treatments in multiple sclerosis. Current therapeutic recommendations. J Neurol 255:1449–1463PubMedCrossRef

63.

Roed HG, Langkilde A, Sellebjerg F et al (2005) A double-blind, randomized trial of IV immunoglobulin treatment in acute optic neuritis. Neurology 64:804–810PubMed

64.

Ross C, Clemmesen KM, Sorensen PS et al (2006) Measuring and evaluating interferon beta-induced antibodies in patients with multiple sclerosis. Mult Scler 12:39–46PubMedCrossRef

65.

Rothfelder U, Neu I, Pelka R (1982) Therapy of multiple sclerosis with immunoglobulin G. MMW Munch Med Wochenschr 124:74–78PubMed

66.

Runmarker B, Andersen O (1995) Pregnancy is associated with a lower risk of onset and a better prognosis in multiple sclerosis. Brain 118(1):253–261PubMedCrossRef

67.

Saccardi R, Kozak T, Bocelli-Tyndall C et al (2006) Autologous stem cell transplantation for progressive multiple sclerosis: update of the European Group for Blood and Marrow Transplantation autoimmune diseases working party database. Mult Scler 12:814–823PubMedCrossRef

68.

Sandberg-Wollheim M, Frank D, Goodwin TM et al (2005) Pregnancy outcomes during treatment with interferon beta-1a in patients with multiple sclerosis. Neurology 65:802–806PubMedCrossRef

69.

Schroder S, Schilli M (2006) „Other circumstances“: on the contribution by Hoffmann LA, Kumpfel T, Heer I et al (2006) Other circumstances“: Pregnancy and immunomodulatory therapy in multiple sclerosis. Nervenarzt 77:663–670CrossRef

70.

Schwarz S, Knorr C, Geiger H et al (2008) Complementary and alternative medicine for Multiple Sclerosis. Mult Scler 14:1113–1119PubMedCrossRef

71.

Siegel J (2005) The product: All intravenous immunoglobulins are not equivalent. Pharmacotherapy 25:78–84CrossRef

72.

Silani V, Cova L (2008) Stem cell transplantation in multiple sclerosis: safety and ethics. J Neurol Sci 265:116–121PubMedCrossRef

73.

Sorensen PS, Haas J, Sellebjerg F et al (2004) IV immunoglobulins as add-on treatment to methylprednisolone for acute relapses in MS. Neurology 63:2028–2033PubMed

74.

Sorensen PS, Wanscher B, Jensen CV et al (1998) Intravenous immunoglobulin G reduces MRI activity in relapsing multiple sclerosis. Neurology 50:1273–1281PubMed

75.

Stangel M, Gold R (2004) Use of i.v. immunoglobulins in neurology. Evidence-based consensus. Nervenarzt 75:801–815PubMedCrossRef

76.

Stangel M, Hartung HP, Marx P et al (1997) Side effects of high-dose intravenous immunoglobulins. Clin Neuropharmacol 20:385–393PubMedCrossRef

77.

Stangel M, Kiefer R, Pette M et al (2003) Side effects of intravenous immunoglobulins in neurological autoimmune disorders – a prospective study. J Neurol 250:818–821PubMedCrossRef

78.

Su L, Xu J, Ji BX et al (2006) Autologous peripheral blood stem cell transplantation for severe multiple sclerosis. Int J Hematol 84:276–281PubMedCrossRef

79.

Teksam M, Tali T, Kocer B et al (2000) Qualitative and quantitative volumetric evaluation of the efficacy of intravenous immunoglobulin in multiple sclerosis: preliminary report. Neuroradiology 42:885–889PubMedCrossRef

80.

Tselis A, Perumal J, Caon C et al (2008) Treatment of corticosteroid refractory optic neuritis in multiple sclerosis patients with intravenous immunoglobulin. Eur J Neurol 15:1163–1167PubMedCrossRef

81.

Vermersch P, Waucquier N, Michelin E et al (2007) Combination of IFN beta-1a (Avonex) and mycophenolate mofetil (Cellcept) in multiple sclerosis. Eur J Neurol 14:85–89PubMedCrossRef

82.

Visser LH, Beekman R, Tijssen CC et al (2004) A randomized, double-blind, placebo-controlled pilot study of i.v. immune globulins in combination with i.v. methylprednisolone in the treatment of relapses in patients with MS. Mult Scler 10:89–91PubMedCrossRef

83.

Vukusic S, Confavreux C (2006) Multiple sclerosis and pregnancy. Rev Neurol 162:299–309PubMedCrossRef

84.

Vukusic S, Hutchinson M, Hours M et al (2004) Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain 127:1353–1360PubMedCrossRef

85.

Walther EU, Hohlfeld R (1999) Multiple sclerosis: side effects of interferon beta therapy and their management. Neurology 53:1622–1627PubMed

86.

Waubant E, Sadovnick AD (2005) Interferon beta babies. Neurology 65:788–789PubMedCrossRef

87.

Wittstock M, Benecke R, Zettl UK (2003) Therapy with intravenous immunoglobulins: complications and side-effects. Eur Neurol 50:172–175PubMedCrossRef

88.

Wordell CJ (1991) Use of intravenous immune globulin therapy: an overview. DICP 25:805–817PubMed

Titel: Intravenöse Immunglobuline bei Multipler Sklerose
Eine Standortbestimmung
verfasst von: Prof. Dr. S. Schwarz
H.-M. Meinck
B. Storch-Hagenlocher
Publikationsdatum: 01.08.2009
Verlag: Springer-Verlag
Erschienen in: Der Nervenarzt / Ausgabe 8/2009
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI: https://doi.org/10.1007/s00115-009-2669-5

Neu in den Fachgebieten Neurologie und Psychiatrie

25.04.2024 | Hypotonie | Nachrichten

Springer Medizin

Intravenöse Immunglobuline bei Multipler Sklerose

Eine Standortbestimmung

Zusammenfassung

Neu in den Fachgebieten Neurologie und Psychiatrie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Demenzkranke durch Antipsychotika vielfach gefährdet

Parkinson-Therapie im Wandel – aktuelle Leitlinie im Fokus

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2009

Die Krise der Neurologie in erkenntnistheoretischer Weise

Integriertes Forschungs- und Behandlungszentrum für Schwindel, Gleichgewichts- und Okulomotorikstörungen

Diagnostik von Schlaganfallursachen

Zentralnervöse Nebenwirkung von Cyclopentolat-Augentropfen

Fußgänger in Berlin nach einem Schlaganfall

Somatoforme Schwindelsyndrome

Neu in den Fachgebieten Neurologie und Psychiatrie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Demenzkranke durch Antipsychotika vielfach gefährdet

Parkinson-Therapie im Wandel – aktuelle Leitlinie im Fokus

Weniger postpartale Depressionen nach Esketamin-Einmalgabe