تاثير درمان باگاماگلبولين وريدي درميوپاتي هاي التهابي مقاوم به درمان رايج

Efficacy of Intravenous Gammaglobulin Therapy in Inflammatory Myopathies Refractory to Conventional-Treatments

The mainstay of pharmacologic therapy in patients with inflammatory myositis is corticosteroid and sometimes immunosuppressive drugs. However, because patients sometimes become refractory to these drugs and since these drugs have potential short and long-term toxicities, an alternate therapy is highly desirable. Therefore, a pilot study was initiated using intravenous gammaglobulin(IVIG) in the treatment of inflammatory myositis. Five adult patients (4 female, 1 male), with mean age of 49 years and chronic refractory myositis (3 polymyositis, 2 dermatomyositis) were treated with high dose of IVIG after the patients had received the following traditional treatments: Prednisolone(n=5), Methotrexate (n=2), Azathioprine(n=3), and Hydroxychloroquine(n=1). Patients received 2gr/kg IVIG 4 days per month. The clinical assessment involved the evaluation of proximal muscle power, esophageal disorder and muscle enzyme level(CPK-LDH). Mean muscle power was estimated before and after IVIG therapy and was found to be significantly improved. Side effect was absent. One patient died due to colon cancer, and one patient with polymyositis relapsed two years after the discontinuation of IVIG. The present study showed the effectiveness of IVIG in the treatment of polymyositis and dermatomyositis, replacing or reducing steroid and immunosuppressive medication.