Abstract
Intravenous immune γ-globulin appears to have a role in the management of some autoimmune-mediated diseases. The exact mechanisms whereby IVIG is beneficial to patients with these diseases are not understood.
The antiphospholipid-antibody syndrome is a recently recognized syndrome in which antibodies to negatively charged phospholipids are associated with a thrombotic diathesis, fetal wastage, and thrombocytopenia. The association between these antibodies and the clinical complaints is unknown. Recent evidence has suggested that a cofactor, a serum protein or glycoprotein (of approx 50 kDa) is essential for so-called antiphospholipid antibodies to bind to phospholipids (46,47). It may be that variations in this cofactor and its binding are some of the factors that determine whether high levels of antiphospholipid antibodies result in pathological consequences.
Patients with antiphospholipid antibodies who have experienced previous fetal losses will continue to experience fetal wastage without some form, of therapeutic intervention (33,34). The optimum therapy for these patients is yet to be determined, but recent isolated anecdotal reports suggest that IVIG may be of some benefit. IVIG appears to be less toxic to the mother than prednisone. The true benefit of IVIG, however, can be determined only by randomized, well controlled trials.
Similar content being viewed by others
References
Corvetta, A., Delia Bitta, R, Gabrielli, A., Spaeth, P. J., and Danieli, G. (1989),Clin. Exp. Rheumatol. 7, 295–299.
Akashi, K., Nagasawa, K., Mayumi, T., Yokota, E., Oochi, N., and Kusaba, T. (1990),J. Rheumatol. 17, 375–379.
Silverman, E. D., Laxer, R M., Greenwald, M., Gelfand, E., Shore, A., Stein, L. D., and Roifman, C. M. (1990),Arthritis Rheum. 33, 1015–1022.
Leung, D. Y. M. (1989),J. Allergy Clin. Immunol. 84, 588–594.
Boey, M. L., Colaco, C. B., Gharavi, A. E., Eklon, K. B., Loizou, S., and Hughes, G. R. V. (1983),BMJ 287, 1021–1023.
Edelman, P. H. G., Rouquette, A. M., Verdy, E., Elias, A., Cabane, J., Cornet, D., Barrat, J., Chavinie, J., Salat-Baroux, J., and Sureau, Cl. (1986),Human Repro. 1, 295–297.
Harris, E. N., Gharavi, A. E., Asherson, R. A., Boey, M. L., and Hughes, G. R. V. (1984),Clin. Exp. Rheum. 2, 247–251.
Unander, A. M., Norberg, R., Hahn, L., and Årfors, L. (1987),Am. J. Obstet. Gynecol. 158, 114–119.
Freyssinet, J. and Cazenave, J. (1987),Throm. Haem. 58, 679–681.
Marciniak, E. and Romond, E. H. (1989),Blood 74, 2426–2432.
Bussel, J. B., Schulman, L., Hilgartner, M. W., and Barandun, S. (1983),J. Pediatr. 103, 651–654.
Mori, P. G., Mancuso, G., Del Principe, D., et al: (1983),Arch. Dis. Child. 58, 851–855.
Newland, A. C., Terleaven, J. G., Minchinton, R. M., and Waters, A. H. (1983),Lancet 1, 84–87.
Bussell, J. B., Goldman, A., Imbach, P., Schulman, I., and Hilgartner, M. W. (1985),J. Pediatr. 106, 886–890.
Ball, S., Zuiable, A., Roter, B. L. T., and Hegde, U. M. (1985),Br. J. Haematol. 60, 631–633.
Nydeger, U. E. and Spycher, M. O. (1986),Clinical Use of Intravenous Immunoglobulins (Morrell, A. and Nydegger U. E., eds.), Academic Press, London, pp. 431–441.
Bussell, J., Pahwa, S., Porges, A., Cunningham-Rundles, S., Koziner, B., Morell, A., and Barandun, S. (1986),J. Clin. Immunol. 6, 50–56.
Imbach, P., Barandun, S., D’Apuzzo, V., Baumgartner, C., Hirt, A., Morell, A., Rossi, E., Scholini, M., Vest, M., and Wagner, H. P. (1981),Lancet 1, 1228–1231.
Fehr, J., Hoffman, V., and Kappeler, U. (1982),N. Engl. J. Med. 306, 1254–1258.
Ballow, M., White, W., and Desbonnet, C. (1989),J. Allergy Clin. Immunol. 84, 595–602.
Jordan, S. C. (1989),Clin. Immunol. Immunopathol. 53, S164-S169.
Ballow, M. and Parke, A. (1989),J. Allergy Clin. Immunol. 84, 608–612.
Newburger, J. W., Takahashi, M., Burns, J. C., et al: (1986),N. Engl. J. Med. 315, 341–347.
DeWolf, F., Carreras, L. O., Moerman, P., Vermylen, J., Van Assche, A., and Renaer, M. (1982),Am. J. Obstet. Gynecol. 142, 829–834.
Nilsson, I. M., Astedt, B., Hedner, U., and Berezin, D. (1975),Acta Med. Scand. 197, 153–159.
Lesperance, B., David, M., Rauch, J., Infante-Rivard, C., and Rivard, G. E. (1988),Thromb. Hemost. 60, 217–219.
Harris, E. N. (1990),Am. J Clin. Pathol. 94, 476–484.
Lockshin, M. D., Druzin, M. L., Goei, S., Qamar, T., Magid, M. S., Jovanovic, L., and Ferenc, M. (1985),N. Engl. J. Med. 313, 152–156.
Maier, D. B. and Parke, A. L. (1989),Fertil. Steril. 51, 280–285.
Parke, A. L., Wilson, D., and Maier, D. The prevalence of antiphospholipid antibodies in habitual aborters, normal mothers and in women who have never been pregnant. (A & R, in press.)
Parke, A. L., Maier, D., Hakim, C., Randolph, J., and Andreoli, J. (1986),J. Rheumatol. 13, 1178–1180.
Stafford-Brady, F. J., Gladman, D. D., and Urowitz, M. B. (1988),Arch. Intern. Med. 148, 1647, 1648.
Lubbe, W. F., Palmer, S. J., Butler, W. S., and Liggins, G. C. (1983),Lancet 1, 1361–1363.
Branch, W. B., Scott, J. R., Kochenour, N. K., and Hershgold, E. (1985),N. Engl. J. Med. 313, 1322–1321.
Walport, M. (1989),Ann. Rheum. Dis. 48, 795–797.
McNeil, H. P., Chesterman, C. N., and Krilis, S. A. (1989),Br. J. Hematol. 73, 506–513.
McVerry, B. A., Spearing, R., and Smith, A. (1985),Br. J. Haematol. 61, 579, 580.
Carreras, L. O., Perez, G. N., Vega, H. R., and Casavilla, F. (1988),Lancet 2, 393,394.
Scott, J. R., Branch, D. W., Kochenour, N. K., and Ward, K. (1988),Am. J. Obstet. Gynecol. 159, 1055, 1056.
Francois, A., Freund, M., Daffos, F., Remy, P., and Jacquot, C. (1988),Ann. Int. Med. 109, 993, 994.
Parke, A., Maier, D., Wilson, D., Andreoli, J., and Ballow, M., (1989),Ann. Int. Med. 110, 495, 496.
Wapner, R. J., Cowchock, F. S., and Shapiro, S. S. (1989),Am. J. Obstet Gynecol. 161, 1271, 1272.
Katz, V. L., Thorp, J. M., Watson, W. J., Fowler, L., and Heine, R. P. H. (1981),Obstet. Gynecol. 58, 430–434.
MacLachlan, N. A., Letsky, E., DeSwiet, M., and Rodeck, C. H. (1990),Clin. Exp. Rheumatol. 8, 221.
Rosove, M. H., Tabsh, K., Wasserstrum, N., Howard, P., Hahn, B. H., and Kalunian, K. C. (1990),Obstet. Gynecol. 75, 630–634.
McNeil, H. P., Simpson, R. J., Chesterman, C. N., and Krilis, S. A. (1991),Proc. Natl. Acad. Sci. USA 87, 4120–4124.
Galli, M., Comfurms, P., Maassen, C., et al. (1990),Lancet 355, 1544–1547.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ann, P. The role of IVIG in the management of patients with antiphospholipid antibodies and recurrent pregnancy losses. Clinical Reviews in Allergy 10, 105–118 (1992). https://doi.org/10.1007/BF02914374
Issue Date:
DOI: https://doi.org/10.1007/BF02914374