ROME, Italy—High dose intravenous immunoglubulin (IVIg) therapy may help improve disease and pregnancy outcomes in expectant women with systemic lupus erythematosus (SLE) who have a history of recurrent miscarriage, according to a study of 24 women published online in Rheumatology.1

"IVIg can be considered effective both in pregnancy outcome and maternal clinical and laboratory features, which strongly ameliorated after IVIg therapy."—Roberto Perricone, MD.
"IVIg can be considered effective both in pregnancy outcome and maternal clinical and laboratory features, which strongly ameliorated after IVIg therapy," conclude researchers led by Roberto Perricone, MD, chief of rheumatology at Policlinico Tor Vergata Hospital in Rome, Italy. "IVIg can be also considered safe as no adverse reactions were observed, pregnancy was led without fetal complications and newborns presented a satisfactory Apgar score."

In the new study, 12 SLE patients with a history of recurrent spontaneous abortion (RSA) were treated with high dose IVIg and 12 SLE-RSA pregnant patients treated with prednisolone and nonsteroidal anti-inflammatory drugs (NSAIDs). The treatment protocol was 0.5 grams IVIg/kg body weight given once every 3 weeks over a 6-hour infusion period (2 mL/min). Treatment ceased on the 33rd week of pregnancy.

IVIg may be steroid-sparing agent in SLE pregnancies

Researchers evaluated the pregnant patients for lupus activity index-pregnancy (LAI-P) scale and for antinuclear antibody, anti-dsDNA, anti Ro/SS-A or La/SS-B, anticardiolipin antibody, lupus anticoagulant, and complement 3 and 4 antibodies before and during pregnancy, as well as before and after each treatment. They also assessed pregnancy outcome in the women.

There was a mean decrease in LAI-P from 0.72 ± 0.43 at the beginning of pregnancy to 0.13 ± 0.19 at the end of pregnancy (P <.0001) in patients who received IVIg therapy. Moreover, antibodies and complement levels normalized in most of the IVIg patients compared with their counterparts who received steroids and NSAIDs. All women treated with IVIg had successful pregnancies with a mean Apgar score of 8.92. Three patients in the control group miscarried.

IVIg may minimize the use of steroids and other immunosuppressive agents that are not as safe, the study authors conclude. "It may be of interest to consider the potential role of IVIg as a short-term adjunctive treatment and a useful steroid-sparing agent in SLE patients during pregnancy."

Other potential uses for IVIg in lupus pregnancy

Jill P. Buyon, MD, rheumatologist at the New York Hospital for Joint Diseases, in New York City, is conducting an open-label study of IVIg in SLE pregnancies related to antiphospholipid antibodies that aims to prevent congenital heart block before it begins. "I need to enroll 19 and have 8 enrolled so far, " she said. The 3 who have been treated have done well.

In general, "the downside of IVIg is cost. It's very expensive and usually requires an infusion suite," Dr. Buyon told MSKreport.com. "While the safety is not fully established, the risks are small as long as the patient is tested for Iga to prevent an allergic reaction."

Reference

 

1. Perricone R, De Carolis C, Kröegler, et al. Intravenous immunoglobulin therapy in pregnant patients affected with systemic lupus erythematosus and recurrent spontaneous abortion. Rheumatology. [published online ahead of print March 17, 2008]. 2008; doi:10.1093/rheumatology/ken046. http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken046v1.