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Rheumatology 2001; 40: 513-521
© 2001 British Society for Rheumatology

Original Papers

Intravenous immunoglobulin application following immunoadsorption: benefit or risk in patients with autoimmune diseases?

S. Schmaldienst, M. Müllner1, A. Goldammer, S. Spitzauer2, S. Banyai, W. H. Hörl and K. Derfler

Department of Medicine III, Division of Nephrology and Dialysis,
1 Department of Emergency Medicine and
2 Department of Laboratory Medicine, University of Vienna, Vienna, Austria

Objective. To evaluate infection rates, side-effects and autoantibody resynthesis after immunoadsorption with and without intravenous immunoglobulin substitution.

Methods. Thirty-five patients with autoimmune diseases who were on long-term immunoadsorption therapy participated in a prospective, randomized study.

Results and conclusions. Infections were rare but similar in frequency in patients receiving combined immunoadsorption and intravenous immunoglobulins (intervention group, n=17, 1.3 infections per patient-year) and in a control group (n=18, 0.9 infections per patient-year) treated by immunoadsorption alone. The reduction in IgG achieved with two immunoadsorptions within 3 days was 95.0±2.5%. The extent of removal of pathogenic autoantibodies was similar to the removal of IgG. Substitution of immunoglobulins was not associated with an increased circulating IgG level before the following immunoadsorption. Infusion of immunoglobulins at a dose of 0.14 g/kg (interquartile range 0.12–0.16) body weight in patients in whom circulating immunoglobulins had been depleted was associated with a high incidence of serious side-effects; these necessitated the termination of treatment in 24% of the patients. No evidence was found that immunoglobulin administration had any beneficial effect with respect to autoantibody resynthesis after immunoadsorption.

KEY WORDS: Immunoadsorption, Intravenous immunoglobulins, Autoimmune disease, Autoantibody resynthesis, Side-effects, Infection.

Correspondence to: S. Schmaldienst, Department of Medicine III, Division of Nephrology and Dialysis, University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria.


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