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- Title
The therapeutic efficacy and safety of intravenous immunoglobulin in dermatomyositis and polymyositis: A systematic review and meta-analysis.
- Authors
Anji Xiong; Yiying Qiang; Yuzi Cao; Yu Shuai; Huini Chen; Qilang Xiang; Ziyi Hu; Zhuoyao Song; Shifeng Zhou; Yan Zhang; Hongxu Cui; Ye Wang; Jie Luo; Shiquan Shuai; Yuan Yang
- Abstract
Objectives: To evaluate the efficacy and safety of intravenous immunoglobulin (IVIG) in the treatment of dermatomyositis (DM) and polymyositis (PM). Methods: We searched PubMed, Embase, and the China National Knowledge Infrastructure for relevant studies from July 1919 to May 2021. Results: Seventeen papers pertinent to our questions were found: In a meta-analysis, we found that IVIG significantly improved the level of CK (SMD (STD. Mean Difference) = -0.69; 95%CI -0.93, -0.46; 푃 < 0.0001), Manual Muscle Test (SMD = 1.12; 95%CI 0.77, 1.47; 푃 < 0.00001), Medical Research Council (SMD = 1.59; 95%CI 0.86, 2.33; 푃 < 0.00001), Activities of Daily Living (SMD = 1.07; 95%CI 0.59, 1.56; 푃 < 0.0001). The CK levels in DM and PM were also significantly improved after IVIG (SMD = -0.73; 95%CI -1.12, -0.34; 푃 = 0.0002 and SMD = -3.29; 95%CI -5.82, -0.76; 푃 < 0.0001, respectively). The meta-analysis of three RCTs showed that there was a statistically significant improvement after IVIG (SMD = 0.63; 95%CI 0.22, 1.03; 푃 = 0.002). In a random effects model, pooled muscle power improvement rate was 77% (95% CI: 66.0-87.0%). Meta-analyses of IVIG as first-line therapy showed a significant improvement of the CK level (SMD = -0.71; 95%CI -1.12, -0.30; 푃 = 0.0007). The polled improvement rate of oesophageal disorders was 88% (95% CI: 80.0-95.0%). There was no statistically significant difference in the rate of improvement between the number of courses <2 and ≥2 (0.80% vs. 0.80%, 푃 = 0.9). The proportion of corticosteroid-sparing success reached 81.8%. Adverse reactions following IVIG administration are usually mild and transient. Seven patients developed serious adverse events. Conclusion: IVIG seems to be an effective drug for DM/PM, improving muscle strength, CK levels, and oesophageal involvement, and it is well tolerated by patients.
- Subjects
CHINA; MEDICAL Research Council (Great Britain); DERMATOMYOSITIS; TREATMENT effectiveness; POLYMYOSITIS; RANDOM effects model; INTRAVENOUS immunoglobulins
- Publication
Modern Rheumatology, 2023, Vol 33, Issue 3, p533
- ISSN
1439-7595
- Publication type
Article
- DOI
10.1093/mr/roac057