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Einsatz intravenöser Immunglobuline in der Neurologie

Ein evidenzbasierter Konsens: Update 2010

Administration of intravenous immunoglobulins in neurology

An evidence-based consensus: update 2010

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Zusammenfassung

In den letzten 5 Jahren ist unser Wissen über Einsatz und Wirksamkeit intravenöser Immunglobuline (IVIg) bei neurologischen Erkrankungen weiter gewachsen. Die Anwendung im ambulanten Bereich wird durch die jetzt verfügbaren Flüssigformulierungen mit hoher Konzentration erleichtert. Trotz eines Anstiegs der weltweiten Plasmaproduktion handelt es sich nach wie vor um ein wertvolles biologisches Produkt, weshalb die aktuellen Indikationen fortlaufend validiert werden müssen. Für die chronisch inflammatorische demyelinisierende Polyneuropathie (CIDP) konnte erstmalig mit dem Präparat Gamunex die Wirksamkeit in der Langzeittherapie gezeigt werden. Bei der myasthenen Verschlechterung erscheint die Gabe von 1 g IVIg/kg Körpergewicht ausreichend zur Stabilisierung der Akutsituation. Weitere neue Indikationen wie das Postpoliosyndrom und der M. Alzheimer werden in klinischen Studien untersucht. Ausgehend vom ersten Konsens im Jahr 2004 wurde die Evidenz zum klinischen Einsatz von IVIg erneut gewichtet und Empfehlungen erarbeitet.

Summary

Our knowledge on the clinical efficacy of intravenous immunoglobulins (IVIg) in neurological diseases has greatly increased in the last 5 years. Liquid formulations with a higher concentration of IVIg have simplified administration. Despite a worldwide increase in plasma production it is still a valuable biological product which is why current indications must be continuously validated. Long-term efficacy of the preparation Gamunex could be demonstrated in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). In acute myasthenic worsening a dose of 1 g IVIg/kg body weight appears to be sufficient for clinical stabilization. New indications, such as the postpolio syndrome or Alzheimer’s disease are being explored in clinical trials. In addition to the consensus statement from 2004 the evidence for clinical use of IVIg has been re-evaluated and recommendations are given.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Mehrere Mitglieder der Konsensusgruppe haben an Studien zu IVIg teilgenommen sowie Honorare für wissenschaftliche Vorträge und Beratertätigkeiten zu IVIg erhalten.

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  1. Neurologische Klinik, OE 7210, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    M. Stangel

  2. Neurologische Klinik, St.-Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Bochum, Deutschland

    R. Gold

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Correspondence to M. Stangel.

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Die Autoren Martin Stangel und Ralf Gold für die IVIg-Konsensusgruppe.

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Stangel, M., Gold, R. Einsatz intravenöser Immunglobuline in der Neurologie. Nervenarzt 82, 415–430 (2011). https://doi.org/10.1007/s00115-010-3059-8

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