TY - JOUR
T1 - Efficacy and safety of intravenous and subcutaneous immunoglobulin therapy in idiopathic inflammatory myopathy
T2 - A systematic review and meta-analysis
AU - Goswami, Rudra Prosad
AU - Haldar, Soumendra Nath
AU - Chatterjee, Moumita
AU - Vij, Pallavi
AU - van der Kooi, Anneke J.
AU - Lim, Johan
AU - Raaphorst, Joost
AU - Bhadu, Danveer
AU - Gelardi, Chiara
AU - Danieli, Maria Giovanna
AU - Kumar, Uma
N1 - Funding Information: Several authors of this publication are members of the Netherlands Neuromuscular Center (NL-NMD), and the European Reference Network for Rare Neuromuscular Diseases EURO-NMD. Publisher Copyright: © 2021 Elsevier B.V.
PY - 2021
Y1 - 2021
N2 - Objective: To perform a systematic review and meta-analysis on the efficacy and safety of intravenous (IVIg) and subcutaneous (SCIg) immunoglobulin (Ig) therapy in the treatment of idiopathic inflammatory myopathy (IIM) and juvenile dermatomyositis (JDM). Methods: PubMed, Embase and SCOPUS were searched to identify studies on Ig therapy in patients with IIM and/or JDM (2010−2020). Outcome measures were complete response (CR) or partial response (PR) in terms of muscle power and extramuscular disease activity measures on the International Myositis Assessment and Clinical Studies Group (IMACS) core set domains. Results: Twenty-nine studies were included (n = 576, 544 IIM, 32 JDM). Muscle power PR with pooled Ig therapy was 88.5% (95% confidence interval (CI): 80.6–93.5, n = 499) and PR with SCIg treatment was 96.61% (95% CI: 87.43–99.15, n = 59). Pooled PR with first-line use of IVIg was 77.07% (95% CI: 61.25–92.89, n = 80). Overall, mean time to response was 2.9 months (95% CI: 1.9–4.1). Relapse was seen in 22.76% (95% CI: 14.9–33). Studies on cutaneous disease activity and dysphagia showed significant treatment responses. Glucocorticoid and immunosuppressant sparing effect was seen in 40.9% (95% CI: 20–61.7) and 42.2% (95% CI: 20.4–64.1) respectively. Ig therapy was generally safe with low risk of infection (1.37%, 95% CI: 0.1–2.6). Conclusions: Add-on Ig therapy improves muscle strength in patients with refractory IIM, but evidence on Ig therapy in new-onset disease and extramuscular disease activity is uncertain.
AB - Objective: To perform a systematic review and meta-analysis on the efficacy and safety of intravenous (IVIg) and subcutaneous (SCIg) immunoglobulin (Ig) therapy in the treatment of idiopathic inflammatory myopathy (IIM) and juvenile dermatomyositis (JDM). Methods: PubMed, Embase and SCOPUS were searched to identify studies on Ig therapy in patients with IIM and/or JDM (2010−2020). Outcome measures were complete response (CR) or partial response (PR) in terms of muscle power and extramuscular disease activity measures on the International Myositis Assessment and Clinical Studies Group (IMACS) core set domains. Results: Twenty-nine studies were included (n = 576, 544 IIM, 32 JDM). Muscle power PR with pooled Ig therapy was 88.5% (95% confidence interval (CI): 80.6–93.5, n = 499) and PR with SCIg treatment was 96.61% (95% CI: 87.43–99.15, n = 59). Pooled PR with first-line use of IVIg was 77.07% (95% CI: 61.25–92.89, n = 80). Overall, mean time to response was 2.9 months (95% CI: 1.9–4.1). Relapse was seen in 22.76% (95% CI: 14.9–33). Studies on cutaneous disease activity and dysphagia showed significant treatment responses. Glucocorticoid and immunosuppressant sparing effect was seen in 40.9% (95% CI: 20–61.7) and 42.2% (95% CI: 20.4–64.1) respectively. Ig therapy was generally safe with low risk of infection (1.37%, 95% CI: 0.1–2.6). Conclusions: Add-on Ig therapy improves muscle strength in patients with refractory IIM, but evidence on Ig therapy in new-onset disease and extramuscular disease activity is uncertain.
KW - IVIg
KW - Idiopathic inflammatory myopathy
KW - Immunoglobulin therapy
KW - SCIg
UR - http://www.scopus.com/inward/record.url?scp=85120168922&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.autrev.2021.102997
DO - https://doi.org/10.1016/j.autrev.2021.102997
M3 - Review article
C2 - 34800685
SN - 1568-9972
JO - Autoimmunity Reviews
JF - Autoimmunity Reviews
M1 - 102997
ER -