PMID- 27390706
OWN - PIP
STAT- PubMed-not-MEDLINE
DCOM- 20160708
LR  - 20220318
IS  - 1016-1430 (Print)
IS  - 2251-6840 (Electronic)
IS  - 1016-1430 (Linking)
VI  - 30
DP  - 2016
TI  - Safety and effectiveness assessment of intravenous immunoglobulin in the 
      treatment of relapsing-remitting multiple sclerosis: A meta-analysis.
PG  - 336
AB  - BACKGROUND: Intravenous immunoglobulin (IVIG) is an established treatment of 
      immune mediated demyelinating neuropathy including Guillain-Barre syndrome and 
      chronic inflammatory demyelinating polyneuropathy. Recent trials suggest its 
      efficacy in treating relapsing- remitting multiple sclerosis. IVIG exerts a 
      number of effects, which may be beneficial in treating multiple sclerosis (MS): 
      Reduction of inflammation, inhibition of macrophages, and promotion of 
      remyelination. The aim of this study was to provide an overall assessment of the 
      existing trials of safety and effectiveness of IVIG in relapsing- remitting MS 
      compared to other drugs currently available for the treatment of disease activity 
      in MS. METHODS: A systematic search strategy was applied to MEDLINE (PubMed and 
      Ovid Medline (1990- Nov 2014)), Cochrane Library 2014, and Trip Database 2014, 
      CRD. The reference lists from the identified trials, MS clinical handbooks and 
      guidelines for the use of IVIG were studied. This article was conducted without 
      language restrictions. Randomized controlled trials of IVIG in MS were selected. 
      Sixteen double-blinded trails were randomly selected. Ten trials were excluded 
      and we performed a meta-analysis on the six trials (537 participants) of IVIG in 
      comparison to placebo. The methodological quality of the trials was assessed 
      using Jadad checklist. RESULTS: The meta-analysis showed a significant beneficial 
      effect on proportion of relapse-free patients (OR: 1.693; 95% CI-1.205-2.380), on 
      the proportion of patients who improved (OR:2.977; 95% CI 1.769-5.010; p=0.0001) 
      and deteriorated (OR:0.522; 95% CI0.330-0.827; p=0.006) between placebo and 
      IVIG-treated patients. In addition, there was a reduction in the annual relapse 
      rate in the IVIG group compared to placebo, which was statistically significant 
      (SMD=-0.218; 95% CI-0.412 to -0.024; p=0.028). The results of the meta-analysis 
      did not show significant differences between Expanded Disability Status Scale 
      (EDSS) changes from baseline (SMD,-0.025; 95% CI,-0.211 to 0.161; p=0.860). 
      CONCLUSION: IVIG can be considered as an alternative therapeutic option, 
      second-line therapy or adjuvant therapy, considering its beneficial effects (high 
      tolerance, need to be injected with longer intervals, etc.) for treating 
      relapsing-remitting MS patients.
FAU - Olyaeemanesh, Alireza
AU  - Olyaeemanesh A
AD  - Assistant Professor, National Institute for Health Research, Tehran University of 
      Medical Sciences, Tehran, Iran. arolyaee@gmail.com.
FAU - Rahmani, Mahbobeh
AU  - Rahmani M
AD  - MSc Student in Health Technology Assessment at Health School Department of Yazd 
      University of Medical Sciences, Iran. Rahmani.mahbobeh@yahoo.com.
FAU - Goudarzi, Reza
AU  - Goudarzi R
AD  - Assistant Professor, PhD in Health Economics, Kerman University of Medical 
      Sciences, Kerman, Iran. rgoudarzi@yahoo.com.
FAU - Rahimdel, Abulghasem
AU  - Rahimdel A
AD  - MD, Assistant Professor of Neurology, Shahid Sadooghi Hospital, Yazd University 
      of Medical Science, Yazd, Iran. Rahimdel30142@yahoo.com.
LA  - eng
PT  - Journal Article
DEP - 20160223
PL  - Iran
TA  - Med J Islam Repub Iran
JT  - Medical journal of the Islamic Republic of Iran
JID - 8910777
PMC - PMC4898867
OTO - NOTNLM
OT  - Intravenous Immunoglobulin
OT  - Meta-analysis
OT  - Multiple sclerosis
OT  - Relapsing-remitting Multiple Sclerosis
EDAT- 2016/07/09 06:00
MHDA- 2016/07/09 06:01
PMCR- 2016/02/23
CRDT- 2016/07/09 06:00
PHST- 2015/09/14 00:00 [received]
PHST- 2015/11/14 00:00 [accepted]
PHST- 2016/07/09 06:00 [entrez]
PHST- 2016/07/09 06:00 [pubmed]
PHST- 2016/07/09 06:01 [medline]
PHST- 2016/02/23 00:00 [pmc-release]
PST - epublish
SO  - Med J Islam Repub Iran. 2016 Feb 23;30:336. eCollection 2016.