Effect of intravenous immunoglobulin on steroid consumption in patients with severe asthma: A double-blind, placebo-controlled, randomized trial

Background: There is a significant group of patients with severe asthma who require chronic use of systemic steroids for control of their disease. The se patients are at risk for severe side effects from oral steroids. Intrave nous immunoglobulin. (IVIG) has immunomodulatory properties, and a few open -label trials have suggested its possible benefit in individuals with sever e asthma. Objective: This study was designed to;assess the potential benefit of MG as a steroid-sparing agent in patients with severe asthma. Methods: Thirty-eight immunocompetent steroid-requiring patients with sever e asthma were randomly enrolled in a double-blind, placebo-controlled trial of MG, Results: Of the 38 patients enrolled, 28 patients completed the study. A si gnificant reduction in oral steroid requirement was observed in both the IV IG-treated (n = 16) and the placebo-treated (n = 12)patients. Further explo ration of the results showed that MG, but not placebo, had a significant st eroid-sparing effect in patients requiring high doses of oral steroids (ie, >2000 mg in the year before the study). Within this subgroup, IVIG treatme nt (n = 9) resulted in a significant decrease in oral Steroid requirement, with a median of 16.4 mg/day during the pretreatment period to 3 mg/day dur ing the treatment phase (P = .0078). No significant decrease in oral steroi d requirement was observed in placebo-treated patients (n = 8) within this subgroup. Objective and subjective parameters of the patients' asthma were unchanged in spite of the: steroid tapering achieved is the group treated w ith MG. Conclusion: IVIG may be a useful steroid-sparing agent in patients with sev ere asthma requiring high doses of oral steroids.