IVIg effectiveness against skin diseases called into question

Rochester, Minn. - Contrary to recent evidence, intravenous immunoglobulin (IVIg) may not be as effective as previously thought for treating various skin diseases, according to a retrospective review reported by the departments of dermatology at the Mayo Clinic, Rochester, Minn.

Bullying bullous disease Reports citing favorable outcomes with the use of IVIg against various types of immunobullous disease and other skin diseases led to the use of IVIg in patients with various forms of recalcitrant skin disease, particularly immunobullous disease seen at the following three Mayo Clinic sites: Rochester, Minn., Jacksonville, Fla. and Scottsdale, Ariz. The experience: it didn't work very well.

Study particulars Of the 18 patients reviewed, 11 adults were treated for immunobullous disease (pemphigus vulgaris - seven; bullous pemphigoid - three; cicatricial pemphigoid - one; dermatomyositis - two; mixed connective tissue disease - one patient; chronic urticaria - one; scleromyxedema - one; leukocytoclastic vasculitis - one; and linear IgA bullous disease - one).

According to the study, responses of patients by type of disease were as follows: pemphigus vulgaris - one partial response (PR), six no response (NR); bullous pemphigoid - one complete response (CR), two NR; cicatricial pemphigoid - one NR; dermatomyositis - one CR, one PR; mixed connective tissue disease - one CR; chronic urticaria - one CR; scleromyxedema - one CR; leukocytoclastic vasculitis - one PR; and linear IgA bullous disease - one CR.

"Nine of the 18 patients had no clinical response to IVIg therapy," Mr. Wetter says. "Six patients experienced complete clinical response and three patients had partial response. All nine non-responders were adult patients with immunobullous disease, and we focused our analysis on that group of patients because they composed the largest subgroup."

Deciphering lack of reaction Recognizing that Mayo's review had several shortcomings, particularly in view of the small numbers and the imperfections associated with a retrospective study and the wide variety of diseases treated, the researchers feel that their experience with IVIg is not as favorable as would be expected from previous reports - especially in the setting of immunobullous disease.

They emphasize that because of the shortcomings, no definitive conclusion could be reached. Nonetheless, the researchers point out that their experience was at variance with previous studies, which indicate the therapy allows for the reduction of concomitant steroids (Ahmed AR. Intravenous immunoglobulin therapy in the treatment of patients with pemphigus vulgaris unresponsive to immunosuppressive treatment. J Am Acad Dermatol. 2001;45:679-690).