Einsatz intravenöser Immunglobuline in der Neurologie: Aktuelle Entwicklungen

Zusammenfassung

In den letzten Jahren gab es beträchtliche Fortschritte in der Behandlung von neurologischen Autoimmunerkrankungen. Teil dieser Entwicklung war auch der Einsatz von hoch dosierten polyklonalen intravenösen Immunglobulinen (IVIg). Auf der Grundlage von randomisierten, plazebokontrollierten, doppelblinden Studien sind IVIg Mittel der ersten Wahl beim Guillain-Barré-Syndrom, der chronisch inflammatorischen demyelinisierenden Polyneuropathie (CIDP) und der multifokalen motorischen Neuropathie (MMN) geworden. Des Weiteren sind IVIg bei rascher Verschlechterung einer Myasthenia gravis indiziert und gelten als Mittel der zweiten Wahl bei Dermatomyositis, Stiff-Person-Syndrom und schwangerschaftsassoziierten bzw. postpartalen Schüben bei multipler Sklerose. Aufgrund der einfachen Handhabung und dem günstigen Nebenwirkungsprofil wurden IVIg sehr großzügig bei den meisten vermeintlich autoimmun vermittelten Erkrankungen eingesetzt oder bei Krankheiten ohne verfügbare zugelassene Therapie. Dies, und die strengen Auflagen für den Produktionsprozess haben zu einem Mangel an IVIg geführt mit der Konsequenz eines drastischen Kostenanstiegs. IVIg sollten daher entsprechend der verfügbaren Daten aus klinischen Studien eingesetzt werden. Wir geben hier eine Übersicht zum klinischen Einsatz und den aktuellen Empfehlungen für IVIg bei neurologischen Erkrankungen.

Abstract

Over the past decade we have observed considerable advances in the treatment of autoimmune-mediated disorders affecting the nervous system. Part of this development was the introduction of high-dose polyclonal intravenous immunoglobulins (IVIg). On the basis of randomised, placebo-controlled, double-blind clinical trials, IVIg has become the first line treatment for Guillain-Barré syndrome, chronic idiopathic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). Furthermore, IVIg can serve as a rescue therapy for patients with rapidly worsening myasthenia gravis, and is a second-line therapy for dermatomyositis, stiff-person syndrome, and pregnancy- or post-partum-associated multiple sclerosis attacks. Due to the excellent safety profile and its uncomplicated administration, IVIg has been used very liberally for most diseases with a suspected autoimmune pathology or where there is no treatment available. This, and the strict licensing requirements, has led to a shortage in IVIg supply and a dramatic increase in costs. Therefore, IVIg should principally be used according to available data from controlled clinical trials. Here we review the clinical applications and recommendations for the use of IVIg in neurological diseases.

Schlüsselwörter

intravenöse Immunglobuline - IVIg - Immunmodulation - Immunneuropathien

Key words

intravenous immunoglobulins - IVIg - immunomodulation - neuropathies

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