[High-dose immunoglobulin therapy in autoimmune diseases].

High-dose intravenous immunoglobulin is being used increasingly as a new therapeutic approach towards various autoimmune diseases, yielding encouraging results predominantly in idiopathic thrombocytopenic purpura (ITP). A marked initial increase of the platelet count has been observed in the majority of patients with acute and chronic ITP alike after high-dose immunoglobulin. In contrast to acute ITP, where full or partial remissions have been achieved in nearly all cases, long-term results reached in chronic ITP, where lasting increases of platelet counts have been observed predominantly in splenectomized patients, have proved to be less favourable. Correspondingly, several cases of other forms of autoimmune thrombocytopenia and neutropenia successfully treated by high-dose immunoglobulin have been reported. We contribute our own experience in 4 patients with myasthenia gravis, where administration of 7S-immunoglobulin but not of 5S-immunoglobulin was followed by both a clinical remission as well as a decrease of specific autoantibody concentration. While several mechanisms of action of high-dose immunoglobulin are discussed, there is evidence for an immunosuppressive effect and for the Fc-fragment dependency of the therapeutic efficacy. Although high-dose immunoglobulin has proved to be a promising therapeutic option especially in ITP, indications will have to be defined yet by further investigations and may be restricted to emergency and refractory cases.