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Einsatz von Immunglobulinen

Therapeutic administration of immunoglobulins

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Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Intravenöse Immunglobuline (IVIG) haben multiple Wirkmechanismen in der Entzündungshemmung. Sie können daher bei vielen Autoimmunerkrankungen eingesetzt werden.

Ziel der Arbeit

Es erfolgt die Beschreibung der Studienlage zum Einsatz von IVIG bei rheumatologischen Erkrankungen.

Methoden

Durchgeführt wurden eine selektive Literaturrecherche und -aufarbeitung zum Thema Wirkmechanismen und Effizienz von IVIG bei rheumatologischen Erkrankungen.

Ergebnisse und Diskussion

Die Therapie mit IVIG hat einen breiten Wirkmechanismus und kann daher bei fast allen Autoimmunerkrankungen Besserungen bringen. Besonders häufig wird IVIG bei den Erkrankungen Immunthrombozytopenie, Kawasaki-Syndrom und den idiopathischen Myositiden eingesetzt. Selten kann IVIG auch bei systemischem Lupus erythematodes, Sjögren-Syndrom mit Neuropathien, katastrophalem Antiphospholipidsyndrom, Sklerodermie, ANCA („antineutrophil cytoplasmic antibody“)-assoziierten Vaskulitiden, Pyoderma gangraenosum und Skleromyxödem indiziert sein. Schwere Nebenwirkungen sind selten. Angesichts der hohen Kosten wird die Therapie in der Regel aber nur in Notfallsituationen, beim Versagen von vorher durchgeführten Standardtherapien oder bei schweren Infektionen und somit Kontraindikation gegen eine Immunsuppression eingesetzt.

Abstract

Background

Intravenously administered immunoglobulins have multiple modes of action that are anti-inflammatory. They can therefore be beneficial in a number of autoimmune disorders.

Objective

The aim of this article is to analyze and summarize studies on the administration of intravenous immunoglobulins in rheumatological diseases.

Methods

A selective search and analysis of the literature was carried out related to the mode of action and efficacy of intravenous immunoglobulins in rheumatological diseases.

Results and conclusion

Intravenous immunoglobulins have a broad mode of action and can therefore be beneficial in almost all autoimmune diseases. Conditions in which they are of special benefit include immunothrombopenia (ITP), Kawasaki disease and idiopathic inflammatory myopathies. In rare situations, they may also be indicated in systemic lupus erythematosus (SLE), Sjögren’s syndrome and neuropathies, catastrophic antiphospholipid syndrome (APS), scleroderma, antineutrophil cytoplasmic antibody (ANCA) associated vasculitis, pyoderma gangrenosum and scleromyxedema. Severe adverse events are rare. In view of the high costs of the therapy, intravenous immunoglobulins are mostly applied in emergency situations, as salvage therapy when other standard therapies have failed or when severe infections are a contraindication to the administration of immunosuppressants.

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Authors and Affiliations

  1. Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    T. Witte

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R.E. Schmidt, Hannover

I. Kötter, Hamburg

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Witte, T. Einsatz von Immunglobulinen. Z Rheumatol 75, 956–963 (2016). https://doi.org/10.1007/s00393-016-0217-9

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