A systematic review on efficacy, safety, and treatment durability of
intravenous immunoglobulin in autoimmune bullous dermatoses: special
focus on indication and combination therapy
Abstract
Background: Autoimmune bullous diseases (AIBDs) are a group of rare
blistering dermatoses of the mucous membrane and/or skin. The efficacy,
safety, and treatment durability of intravenous immunoglobulin (IVIg) as
an alternative treatment should be explored. Objectives: To
systematically review the available literature regarding treatment
outcomes with IVIg in AIBD patients. Methods: The predefined search
strategy was incorporated into the following database, MEDLINE/PubMed,
Embase, Scopus, and Web of Science on 18th July 2022. Sixty studies were
enrolled using Preferred Reporting Items for Systematic Reviews and
Meta-analyses guidelines. Results: The use of IVIg alone or combined
with rituximab was reported in 500 patients with pemphigus, 82 patients
with bullous pemphigoid, 146 patients with mucous membranes pemphigoid,
and 19 patients with epidermolysis bullosa acquisita. IVIg therapy
induced disease remission of 82.8% in pemphigus, 88% in bullous
pemphigoid, 91.3% in mucous membranes pemphigoid, and 78.6% in
epidermolysis bullosa acquisita. The combination therapy of RTX+IVIg led
to disease remission of 86.7% in pemphigus, 100% in bullous
pemphigoid, and 75.0% in mucous membranes pemphigoid. Among all the
included patients, 37.5% experienced at least one IVIg-related side
effect; the most common ones were headaches, fever/chills, and
nausea/vomiting. Conclusions: The use of IVIg with or without rituximab
had a favorable clinical response in patients with AIBDs. IVIg has no
major influence on the normal immune system, which makes its utilization
for patients with AIBDs reasonable.