Efficacy and safety of intravenous immunoglobulin in patients with lupus nephritis: A systematic review of the literature |
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| Institution: | 1. Rheumatology department, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Cra 19 No. 8A – 32, 111411 Bogotá, Colombia;2. Internal Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia, Cra 19 No. 8A – 32, 111411 Bogotá, Colombia;3. Research Institute, Fundación Universitaria de Ciencias de la Salud (FUCS), Cra 19 No. 8A – 32, 111411 Bogotá, Colombia;1. Center for Blistering Diseases, Department of Dermatology, Tufts University School of Medicine, Boston, MA, USA;2. Chief Pediatric Pulmonary Medicine, Mass General Hospital, Harvard Medical School, Boston, MA, USA;1. Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares, Hôpital Pitié-Salpêtrière, 75013 Paris, France;2. Sorbonne Université, APHP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013 Paris, France;3. Sorbonne Université, INSERM, UMRS_1166-ICAN, ICAN, Paris, France.;1. Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China;2. Shanxi Key Laboratory of Immunomicroecology, Taiyuan, China;3. Department of Rheumatology, Linyi Central Hospital, Linyi, China;4. Pathology, Joint Program in Transfusion Medicine, Brigham and Women’s Hospital/Children’s Hospital, Harvard Medical School, Boston, MA, USA;1. Department of Translational Research of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy;2. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy;3. Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy;4. Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy;5. MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence Center, Center for Research and Innovation CRIA-MASVE, Firenze, Italy;6. Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy;7. Rheumatology Clinic ''Madonna Dello Scoglio'' Cotronei, Crotone, Italy;1. Rheumatology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Rua Conceição Fernandes, s/n, 4434-502 Vila Nova de Gaia, Portugal;2. Division of Rheumatology, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;1. Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (CSUR) of the Spanish Health System, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain;2. Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain;3. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina 04100, Italy;4. Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Catalonia, Spain;5. Department of Hemotherapy and Hemostasis, Hospital Clinic, Barcelona, Catalonia, Spain;6. Department of Nephrology and Renal Transplantation, Hospital Clinic, Barcelona, Catalonia, Spain |
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| Abstract: | Introduction and objectiveIntravenous immunoglobulin (IVIg) is an anti-inflammatory drug with an unclear role in the treatment of patients with lupus nephritis (LN). This systematic review evaluates the evidence for IVIg in the care of patients with LN.MethodologyA systematic search was done in the PubMed, EMBASE, BVS and OVID databases – All EBM Reviews following the PRISMA methodology (registration in PROSPERO CRD42021236662). The variables were extracted: indications for use, dosage, partial or complete response, adverse reactions, initiation of renal replacement therapy, reduction of proteinuria, and mortality. The quality assessment was done with the “The Joanna Briggs Institute (JBI) Critical Appraisal tools for use in Systematic Reviews Checklist”. In addition, synthesis reports were prepared through the Synthesis Without Meta-analysis – SWiM guide.ResultsA total of 2328 articles were obtained (28 were considered for inclusion). When the studies were evaluated, IVIg therapy was found to be between 60% to 70% effective (except for patients with class V LN) with overall responses (complete + partial) even for patients who are refractory to first line treatment. Normalization (<0.5 g) of nephrotic proteinuria occurred in 24% of cases with infrequent adverse events and a mortality plus dialysis composite of 11.5% and 24.1% (most representative study).ConclusionIn patients with LN refractory to conventional treatment or co-infection situations, the reported data seem to demonstrate effectiveness of IVIg therapy. There are few adverse reactions and caution is exercised when using it on patients with class V NL. However, given the lack of controlled studies with long-term follow-up, these data should be interpreted cautiously thus encouraging the development of high-quality RCTs. |
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