Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Intravenous immunoglobulin (IVIG) is sometimes used as a treatment for systemic lupus erythematosus (SLE), particularly in specific scenarios such as severe or refractory disease, when conventional immunosuppressive therapies have failed or are contraindicated, or in the presence of severe infections. The scientific rationale for IVIG use in lupus is based on its immunomodulatory properties: IVIG can neutralize autoantibodies, modulate Fc receptor expression and function, inhibit complement activation, and suppress inflammatory cytokines, all of which are relevant to the pathogenesis of SLE.

Clinical evidence supporting IVIG’s efficacy in lupus is moderate and primarily comes from case series, small open-label studies, and a few randomized controlled trials. These studies suggest that IVIG can be beneficial in treating certain lupus manifestations, such as lupus nephritis, neuropsychiatric lupus, and hematological complications. However, the overall quality of evidence is limited by small sample sizes and methodological heterogeneity. Major guidelines (e.g., EULAR, ACR) consider IVIG as a second- or third-line therapy, reserved for refractory cases or when standard therapies are unsuitable.

In summary, there is scientific but not robust evidence supporting the use of immunoglobulin in selected lupus patients, with its use being largely restricted to special situations rather than as a first-line treatment.

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