IV immune globulin relieves neuropathy in primary Sjögren's syndrome

NEW YORK (Reuters Health) - Intravenous immunoglobulin (IVIg) may offer some relief for patients with sensorimotor neuropathy or nonataxic sensory neuropathy associated with primary Sjögren's syndrome, researchers from France report.

IVIg is an established therapy for chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, and Guillain-Barré syndrome, and several case reports have suggested that IVIg may have value in Sjögren's syndrome-associated peripheral neuropathy.

Dr. Xavier Mariette from Hôpital de Bicêtre, Le Kremlin Bicêtre, and colleagues in Club Rhumatismes et Inflammation assessed the effects and tolerability of IVIg treatment in a small retrospective study of 19 Sjögren's syndrome patients (mean age, 60 years) with neuropathy (median duration of neuropathy, 9 years).

Patients received intravenous IVIg (2 g/kg) for 5 days a month (10 patients) or 2 days a month (9 patients) for a median 7 months. Response was assessed using the disability Modified Rankin Scale and a global evaluation by the practitioner.

Results, with a median follow-up of 27 months, were published online May 16 in Arthritis Care & Research.

All five patients with sensorimotor neuropathy, all four with nonataxic sensory neuropathy, and the sole patient with conduction block improved or stabilized on IVIg therapy. In contrast, only two of nine patients with ataxic neuropathy improved, and four worsened. Disease remained stable in the other three patients.

The nine patients who had dramatic improvements showed responses after only two infusions.

"Because of the gravity of peripheral neuropathy and the absence of efficient treatment, even the stabilization of clinical symptoms would be a valuable goal since the natural course of this disease leads to a spontaneous and continuous aggravation," the researchers note.

After four to 12 months of treatment, five patients were able to have their IVIg infusions spaced every two or three months.

Ten of 13 patients who required corticosteroids were able to reduce their prednisone dosage from an average of 15 mg daily before IVIg to 10 mg after IVIg.

There were no severe side effects associated with IVIg treatment, and only one patient stopped treatment after one infusion because of nausea and lack of initial efficacy.

"Taking into account our results, from a practical point of view, symptomatic treatment should be tested in patients with Sjögren's syndrome without necrotizing vasculitis related neuropathy," the investigators conclude. "In this case, IVIg may be tried for at least two courses (and thus evaluation at the time of the 3rd course)."

"Further studies are necessary to investigate the optimal number of IVIg courses necessary to assess definitely the efficacy or the failure of the treatment, and to know how long the treatment should be continued," they add. "These studies should probably focus on one type of neuropathy (probably the sensorimotor or nonataxic sensory polyneuropathy)."

Source: https://bit.ly/mT68wJ

Arthritis Care Res 2011.

Last Updated: 2011-06-30 14:05:16 -0400 (Reuters Health)

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