Clinical Question: Does intravenous...

Clinical Question: Does intravenous immunoglobulin delay the growth of multiple sclerosis following an initial neurologic end associated with demyelination?

Setting: Outpatient (specialty)

cogitation Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: Patients were eligible for this research if they were between 15 and 50 years of age and had a first well-defined neurologic consequence consistent with multiple sclerosis that was confirmed by way of neurologic examination and brain magnetic resonance imaging in the preceding 90 days. They also had to experience finished or partial regression of symptoms.

Patients were assigned randomly (method of allocation concealment not described) to receive a loading dose of 04 g through kg intravenous immunoglobulin for five consecutive days followed through 0.4 g per kg one time every six weeks for united year (n = 45). The rule group received disguised normal saline infusions (n = 46) A neurologist unaware of treatment assignment examined each patient each three months. If a relapse was suspected, brace neurologists would independently examine the patient. forward confirmation of a relapse through one of the two neurologists, the patient was withdrawn from the contemplation Relapse was defined as the assault of new neurologic symptoms suggestive of white matter involvement occurring for a period of at least 48 hours and accompanied according to objective neurologic findings.

The primary extreme point point, assessed by intention to treat, was defined as the number of patients who experienced a next to the first attack within one year. This criterion establishes the diagnosis of multiple sclerosis. At the expiration of one year, 26 percent of patients treated with intravenous immunoglobulin cause to growed a second event compared with 50 percent of patients treated with placebo (P = 03) In other words, four patients would ne to be treated with intravenous immunoglobulin for united year to delay one patient from developing a secondary event (95 percent confidence interval, three to 30)

Bottom Line: from one side of to the other one year, intravenous immunoglobulin delays a next to the first neurologic event consistent with multiple sclerosis in patients presenting with an initial issue of demyelination. The effect beyond undivided year is unknown. (Level of Evidence: 1b)

thought Reference: Achiron A, et al. Intravenous immunoglobulin treatment following the first demyelinating circumstance suggestive of multiple sclerosis: a randomized, double-blind, placebo-controlled trial. Arch Neurol October 2004;61:1515-20

Used with permission from Barry H IV immunoglobulin delays storm of MS. Accessed online November 24 2004 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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