High dose IVIG in the post partum period for prevention of exacerbations in MS.

The influence of pregnancy on the course of autoimmune diseases is well documented. In multiple sclerosis the European PRIMS study confirmed an ameliorating effect during pregnancy but on increase of exacerbations after delivery. The efficacy of IVIG in autoimmune mediated diseases has been frequently reported. Based on the experiences of Achiron we recommend IVIG to prevent exacerbations after delivery. Since 1995 we recommend 60 g IVIG within 3 days after delivery and 10 g monthly in patients estimated to be on high risk for exacerbation. The data were compared to the PRIMS study. The baseline data were comparable, but the exacerbation rate after delivery in our observation was 33% lower than expected. The lowest risk for an exacerbation within the first 3 months after delivery we observed in women treated with long-term IVIG monthly. Until now the overall tolerance was excellent The results with IVIG after delivery suggest that immunoglobulins may be a promising therapeutical approach not only in MS but also in other autoimmune mediated diseases with a risk of exacerbation after delivery. A European wide study with IVIG after delivery in MS is in preparation to confirm our preliminary data.