Department of Rheumatology, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing 100029, China.
Clin Rheumatol. 2012 May;31(5):801-6. doi: 10.1007/s10067-012-1940-5. Epub 2012 Jan 26.
The objectives of this study are to review and summarize published information on the use, effectiveness, and adverse effects of intravenous immunoglobulin (IVIG) in patients with polymyositis (PM) or dermatomyositis (DM) and to search MEDLINE and CNKI (Chinese) databases from 1985 to 2011 to retrieve clinical research articles concerning IVIG in adult patients with PM/DM. Of the 14 articles selected, two were randomized controlled trials, nine prospective open studies, and three retrospective studies with a total of 308 adult patients. IVIG has been used successfully in the treatment of PM/DM. The standard dose is 2 g/kg, given in two to five individual daily doses. The course of IVIG treatment is usually 3~6 months. IVIG therapy seemed rarely employed as first-line therapy in PM/DM. In a double-blind study conducted in patients with refractory DM, IVIG combined with corticosteroid significantly improved muscle strength and decreased serum creatine kinase level, compared with placebo. The beneficial effect of IVIG in refractory, flare-up, rapidly progressive, or severe PM/DM has been documented in many open-label trials. IVIG was shown to be effective in most of PM/DM patients with lung involvement and esophageal involvement. In some patients, IVIG can lower the corticosteroid dose required for maintenance, demonstrating the most effective steroid-sparing effect. Adverse effects were generally tolerable. IVIG is effective in the treatment of adult patients with PM/DM and appears to be relatively well tolerated and safe. IVIG may be a good choice especially in patients with refractory, flare-up, rapidly progressive, or severe PM/DM, and can be tried in patients with a contraindication for corticosteroid.
本研究旨在回顾和总结已发表的关于静脉注射免疫球蛋白（IVIG）在多发性肌炎（PM）或皮肌炎（DM）患者中的应用、疗效和不良反应的信息，并检索 1985 年至 2011 年间 MEDLINE 和中国知网（CNKI）数据库中有关成人 PM/DM 患者 IVIG 的临床研究文章。在选择的 14 篇文章中，有 2 篇是随机对照试验，9 篇是前瞻性开放研究，3 篇是回顾性研究，共纳入 308 例成年患者。IVIG 已成功应用于 PM/DM 的治疗。标准剂量为 2 g/kg，分 25 天给予，疗程通常为 36 个月。IVIG 治疗似乎很少作为 PM/DM 的一线治疗。在一项针对难治性 DM 患者的双盲研究中，与安慰剂相比，IVIG 联合皮质类固醇显著改善了肌肉力量并降低了血清肌酸激酶水平。许多开放标签试验证明了 IVIG 在难治性、发作性、快速进展性或严重 PM/DM 中的有益作用。IVIG 对大多数合并肺或食管受累的 PM/DM 患者有效。在一些患者中，IVIG 可以降低维持所需的皮质类固醇剂量，显示出最有效的激素节约作用。不良反应一般可以耐受。IVIG 对成人 PM/DM 患者有效，且似乎具有较好的耐受性和安全性。IVIG 可能是一种较好的选择，尤其适用于难治性、发作性、快速进展性或严重 PM/DM 患者，并且可以在对皮质类固醇有禁忌证的患者中尝试使用。
