Intravenous immunoglobulin application following immunoadsorption: benefitor risk in patients with autoimmune diseases?

Objective. To evaluate infection rates, side-effects and autoantibody resyn thesis after immunoadsorption with and without intravenous immunoglobulin s ubstitution. Methods. Thirty-five patients with autoimmune diseases who were on long-ter m immunoadsorption therapy participated in a prospective, randomized study. Results and conclusions. Infections were rare but similar in frequency in p atients receiving combined immunoadsorption and intravenous immunoglobulins (intervention group, n = 17, 1.3 infections per patient-year) and in a con trol group (n = 18, 0.9 infections pet patient-year) treated by immunoadsor ption alone. The reduction in IgG achieved with two immunoadsorptions withi n 3 days was 95.0 +/- 2.5%. The extent of removal of pathogenic autoantibod ies was similar to the removal of IgG. Substitution of immunoglobulins was not associated with an increased circulating IgG level before the following immunoadsorption. Infusion of immunoglobulins at a dose of 0.14 g.kg (inte rquartile range 0.12-0.16) body weight in patients in whom circulating immu noglobulins had been depleted was associated with a high incidence of serio us side-effects; these necessitated the termination of treatment in 24% of the patients. No evidence was found that immunoglobulin administration had any beneficial effect with respect to autoantibody resynthesis after immuno adsorption.