Treatment with intravenous immunoglobulins (IVIg) does not facilitate corticosteroid dose reduction in corticosteroid-dependent myasthenia

Intravenous immunoglobulins (IVIg) have shown, for several autoimmune diseases, a cortisone-sparing effect. An international team conducted a clinical trial to assess this effect in the myasthenia gravis. The multicenter, randomized, double-blind, placebo-controlled study included 60 corticosteroid-dependent patients, aged 18 to 85.

• Patients in the IVIG group received a first dose of 2g/kg, then an injection every three weeks of 1g/kg for 36 weeks. Corticosteroid therapy was gradually reduced when possible (no clinical worsening).
• The number of patients who were able to reduce their initial dose of corticosteroids by at least 50% (approximately 60% of patients) was not significantly different between the two groups. Nor is the percentage reduction in daily doses in the two groups.
• The synergistic effect of IVIG and corticosteroids, shown in certain studies, was not observed here, suggesting different mechanisms of action of corticosteroids and IVIG.

A Randomized, Double-Blind, Placebo-Controlled Trial of the Corticosteroid-Sparing Effects of Immunoglobulin in Myasthenia Gravis. Bril, V., Szczudlik, A., Vaitkus, A. et al. Neurology Oct. 2022, 10.1212/WNL.0000000000201501.

From the Clinicaltrials.gov website: NCT02473965

See as well ” Myasthenia gravis and corticosteroids: what effects of immunoglobulin therapy ? »