Inmunoglobulinas intravenosas en pacientes hospitalizados con miopatía inflamatoria idiopática
Palabras clave:
inmunoglobulina intravenosa (IGIV), miopatías inflamatorias idiopáticas, dermatomiositis, polimiositis
Resumen
Introducción: la inmunoglobulina intravenosa (IGIV) se ha utilizado especialmente en miopatías inflamatorias idiopáticas (MII) refractarias o graves. Objetivos: describir la prevalencia de uso y las variables asociadas con la terapia con IGIV durante la hospitalización en pacientes con MII. Materiales y métodos: se realizó un estudio retrospectivo en pacientes hospitalizados desde 2015 hasta 2023 con MII. Se describieron las variables asociadas con el uso de IGIV. Resultados: se analizaron 46 hospitalizaciones de pacientes con MII, con predominio del sexo femenino, y una edad media de 50,8 años. El fenotipo más frecuente fue dermatomiositis (76,1%); de estos, 24 pacientes (52%) recibieron tratamiento con IGIV. Este grupo presentó: mayor prevalencia de disfagia (83,3% vs. 36,4%; p<0,001), particularmente en grados moderados (29,2% vs. 9,1%) y graves (33,3% vs. 0%; p<0,001), mayor frecuencia de autoanticuerpos (70,8% vs 36,4%; p=0,04) y mayor proporción de recaídas como causa de hospitalización (54,2% vs. 22,7%; p=0,03). Aunque la mediana de creatinina fosfoquinasa fue mayor en el grupo IGIV (2030 mg/dl; RIC: 150-6955), no hubo diferencias significativas respecto del grupo control (p=0,18). La IGIV fue bien tolerada y no se registraron eventos adversos. Conclusiones: la disfagia y la recaída de la MII fueron las principales variables relacionadas con la indicación de IGIV.Citas
I. Rider LG, Werth VP, Huber AM, et al. Measures of adult and juvenile dermatomyositis, polymyositis, and inclusion body myositis: Physician and Patient/Parent Global Activity, Manual Muscle Testing (MMT), Health Assessment Questionnaire (HAQ)/Childhood Health Assessment Questionnaire (C-HAQ), Childhood Myositis Assessment Scale (CMAS), Myositis Disease Activity Assessment Tool (MDAAT), Disease Activity Score (DAS), Short Form 36 (SF-36), Child Health Questionnaire (CHQ), physician global damage, Myositis Damage Index (MDI), Quantitative Muscle Testing (QMT), Myositis Functional Index-2 (FI-2), Myositis Activities Profile (MAP), Inclusion Body Myositis Functional Rating Scale (IBMFRS), Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI), Cutaneous Assessment Tool (CAT), Dermatomyositis Skin Severity Index (DSSI), Skindex, and Dermatology Life Quality Index (DLQI). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11(0 11):S118-57. doi: 10.1002/acr.20532.
II. Aggarwal R, Rider LG, Ruperto N, et al. International Myositis Assessment and Clinical Studies Group and the Paediatric Rheumatology International Trials Organisation. 2016 American College of Rheumatology/European League Against Rheumatism criteria for minimal, moderate, and major clinical response in adult dermatomyositis and polymyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Ann Rheum Dis. 2017 May;76(5):792-801. doi: 10.1136/annrheumdis-2017-211400.
III. Lundberg IE, Tjärnlund A, Bottai M, et al. 2017 European League against Rheumatism/American College of rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis2017;76:1955-64.doi:10.1136/annrheumdis-2017-211468.
IV. Furst DE, Amato AA, Iorga SR, et al. Epidemiology of adult idiopathic inflammatory myopathies in a U.S. managed care plan. Muscle Nerve. 2012 May;45(5):676-83. doi: 10.1002/mus.23302.
V. Bamrungsawad N, Chaiyakunapruk N, Upakdee N, et al. Cost-utility analysis of intravenous immunoglobulin for the treatment of steroid-refractory dermatomyositis in Thailand. Pharmacoeconomics. 2015 May;33(5):521-31. doi: 10.1007/s40273-015-0269-8.
VI. Danieli MG, Gelardi C, Pedini V, et al. Subcutaneous immunoglobulin in inflammatory myopathies: efficacy in different organ systems. Autoimmun Rev. 2020 Jan;19(1):102426. doi: 10.1016/j.autrev.2019.102426.
VII. Danieli MG, Moretti R, Gambini S, et al. Open-label study on treatment with 20% subcutaneous IgG administration in polymyositis and dermatomyositis. Clin Rheumatol. 2014 Apr;33(4):531-6. doi: 10.1007/s10067-013-2478-x.
VIII. Gelfand EW. Intravenous immune globulin in autoimmune and inflammatory diseases. N Engl J Med. 2012 Nov 22;367(21):2015-25. doi: 10.1056/NEJMra1009433.
IX. Aggarwal R, Charles-Schoeman C, Schessl J. Trial of intravenous immune globulin in dermatomyositis. Reply. N Engl J Med. 2023 Jan 5;388(1):94-95. doi: 10.1056/NEJMc2214285.
X. Hachulla E, Benveniste O, Hamidou M, et al. High dose subcutaneous immunoglobulin for idiopathic inflammatory myopathies and dysimmune peripheral chronic neuropathies treatment: observational study of quality of life and tolerance. Int J Neurosci. 2017 Jun;127(6):516-523. doi: 10.1080/00207454.2016.1204544.
XI. Quick A, Tandan R. Mechanisms of action of intravenous immunoglobulin in inflammatory muscle disease. Curr Rheumatol Rep. 2011 Jun;13(3):192-8. doi: 10.1007/s11926-011-0171-0.
XII. Dourmishev LA, Guleva DV, Miteva LG. Intravenous immunoglobulins. Mode of action and indications in autoimmune and inflammatory dermatoses. Int J Inflam. 2016;2016:3523057. doi: 10.1155/2016/3523057.
XIII. Mulhearn B, Bruce IN. Indications for IVIG in rheumatic diseases. Rheumatology (Oxford). 2015 Mar;54(3):383-91. doi: 10.1093/rheumatology/keu429.
XIV. Kaufman GN, Massoud AH, Dembele M, et al. Induction of regulatory T cells by intravenous immunoglobulin. A bridge between adaptive and innate immunity. Front Immunol. 2015 Sep 11;6:469. doi: 10.3389/fimmu.2015.00469.
XV. Cámpora H, Falduti A. Evaluación y tratamiento de las alteraciones de la deglución. Rev Am Med Respir 2012;12(3):98-107.
XVI. Dalakas MC, Illa I, Dambrosia JM, Soueidan SA, Stein DP, Otero C, et al. A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med. 1993 Dec 30;329(27):1993-2000. doi: 10.1056/NEJM199312303292704.
XVII. Tian JGJS, Chen JW, Li F, Xie X, Du JF. Efficacy and safety of the combined treatment with intravenous immunoglobulin and oral glucocorticoid in the elderly with dermatomyositis. Chin J Geriatr. 2008;27:588-90.
XVIII. Miyasaka N, Hara M, Koike T, Saito E, Yamada M, Tanaka Y, et al. Effects of intravenous immunoglobulin therapy in Japanese patients with polymyositis and dermatomyositis resistant to corticosteroids: a randomized double-blind placebo-controlled trial. Mod Rheumatol. 2012 Jun;22(3):382-93. doi: 10.1007/s10165-011-0534-4.
XIX. Aggarwal R, Charles-Schoeman C, Schessl J, et al. Trial of intravenous immune globulin in dermatomyositis. N Engl J Med. 2022 Oct 6;387(14):1264-1278. doi: 10.1056/NEJMoa2117912.
XX. Cherin P, Piette JC, Wechsler B, et al. Intravenous gamma globulin as first line therapy in polymyositis and dermatomyositis: an open study in 11 adult patients. J Rheumatol. 1994 Jun;21(6):1092-7.
XXI. Galimberti F, Kooistra L, Li Y, et al. Intravenous immunoglobulin is an effective treatment for refractory cutaneous dermatomyositis. Clin Exp Dermatol. 2018 Dec;43(8):906-912. doi: 10.1111/ced.13607.
XXII. Genevay S, Saudan-Kister A, Guerne PA. Intravenous gammaglobulins in refractory polymyositis: lower dose for maintenance treatment is effective. Ann Rheum Dis. 2001 Jun;60(6):635-6. doi: 10.1136/ard.60.6.635.
XXIII. Marie I, Menard JF, Hatron PY, et al. Intravenous immunoglobulins for steroid-refractory esophageal involvement related to polymyositis and dermatomyositis: a series of 73 patients. Arthritis Care Res (Hoboken). 2010 Dec;62(12):1748-55. doi: 10.1002/acr.20325.
XXIV. Giannini M, Fiorella ML, Tampoia M, et al. Long-term efficacy of adding intravenous immunoglobulins as treatment of refractory dysphagia related to myositis: a retrospective analysis. Rheumatology (Oxford). 2021 Mar 2;60(3):1234-1242. doi: 10.1093/rheumatology/keaa443.
XXV. Barsotti S, Cavazzana I, Zanframundo G, Neri R, Taraborelli M, Cioffi E, et al. Real life picture of the use of intravenous immunoglobulins in idiopathic inflammatory myopathies: results of a multicentric study. Autoimmun Rev. 2021 Mar;20(3):102757. doi: 10.1016/j.autrev.2021.102757.
XXVI. Wang LM, Yang QH, Zhang L, et al. Intravenous immunoglobulin for interstitial lung diseases of anti-melanoma differentiation-associated gene 5-positive dermatomyositis. Rheumatology (Oxford). 2022 Aug 30;61(9):3704-3710. doi: 10.1093/rheumatology/keab928.
XXVII. Oldroyd AGS, Lilleker JB, Amin T, et al. British Society for Rheumatology Standards, Audit and Guidelines Working Group. British Society for Rheumatology guideline on management of paediatric, adolescent and adult patients with idiopathic inflammatory myopathy. Rheumatology (Oxford). 2022 May 5;61(5):1760-1768. doi: 10.1093/rheumatology/keac115.
XXVIII. Dalakas MC, Koffman B, Fujii M, et al. A controlled study of intravenous immunoglobulin combined with prednisone in the treatment of IBM. Neurology. 2001 Feb 13;56(3):323-7. doi: 10.1212/wnl.56.3.323.
XXIX. Wang DX, Shu XM, Tian XL, et al. Intravenous immunoglobulin therapy in adult patients with polymyositis/dermatomyositis: a systematic literature review. Clin Rheumatol. 2012 May;31(5):801-6. doi: 10.1007/s10067-012-1940-5.
XXX. Anh-Tu Hoa S, Hudson M. Critical review of the role of intravenous immunoglobulins in idiopathic inflammatory myopathies. Semin Arthritis Rheum. 2017 Feb;46(4):488-508. doi: 10.1016/j.semarthrit.2016.07.014.
XXXI. Danieli MG, Tonacci A, Paladini A, et al. A machine learning analysis to predict the response to intravenous and subcutaneous immunoglobulin in inflammatory myopathies. A proposal for a future multi-omics approach in autoimmune diseases. Autoimmun Rev. 2022 Jun;21(6):103105. doi: 10.1016/j.autrev.2022.103105.
II. Aggarwal R, Rider LG, Ruperto N, et al. International Myositis Assessment and Clinical Studies Group and the Paediatric Rheumatology International Trials Organisation. 2016 American College of Rheumatology/European League Against Rheumatism criteria for minimal, moderate, and major clinical response in adult dermatomyositis and polymyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Ann Rheum Dis. 2017 May;76(5):792-801. doi: 10.1136/annrheumdis-2017-211400.
III. Lundberg IE, Tjärnlund A, Bottai M, et al. 2017 European League against Rheumatism/American College of rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis2017;76:1955-64.doi:10.1136/annrheumdis-2017-211468.
IV. Furst DE, Amato AA, Iorga SR, et al. Epidemiology of adult idiopathic inflammatory myopathies in a U.S. managed care plan. Muscle Nerve. 2012 May;45(5):676-83. doi: 10.1002/mus.23302.
V. Bamrungsawad N, Chaiyakunapruk N, Upakdee N, et al. Cost-utility analysis of intravenous immunoglobulin for the treatment of steroid-refractory dermatomyositis in Thailand. Pharmacoeconomics. 2015 May;33(5):521-31. doi: 10.1007/s40273-015-0269-8.
VI. Danieli MG, Gelardi C, Pedini V, et al. Subcutaneous immunoglobulin in inflammatory myopathies: efficacy in different organ systems. Autoimmun Rev. 2020 Jan;19(1):102426. doi: 10.1016/j.autrev.2019.102426.
VII. Danieli MG, Moretti R, Gambini S, et al. Open-label study on treatment with 20% subcutaneous IgG administration in polymyositis and dermatomyositis. Clin Rheumatol. 2014 Apr;33(4):531-6. doi: 10.1007/s10067-013-2478-x.
VIII. Gelfand EW. Intravenous immune globulin in autoimmune and inflammatory diseases. N Engl J Med. 2012 Nov 22;367(21):2015-25. doi: 10.1056/NEJMra1009433.
IX. Aggarwal R, Charles-Schoeman C, Schessl J. Trial of intravenous immune globulin in dermatomyositis. Reply. N Engl J Med. 2023 Jan 5;388(1):94-95. doi: 10.1056/NEJMc2214285.
X. Hachulla E, Benveniste O, Hamidou M, et al. High dose subcutaneous immunoglobulin for idiopathic inflammatory myopathies and dysimmune peripheral chronic neuropathies treatment: observational study of quality of life and tolerance. Int J Neurosci. 2017 Jun;127(6):516-523. doi: 10.1080/00207454.2016.1204544.
XI. Quick A, Tandan R. Mechanisms of action of intravenous immunoglobulin in inflammatory muscle disease. Curr Rheumatol Rep. 2011 Jun;13(3):192-8. doi: 10.1007/s11926-011-0171-0.
XII. Dourmishev LA, Guleva DV, Miteva LG. Intravenous immunoglobulins. Mode of action and indications in autoimmune and inflammatory dermatoses. Int J Inflam. 2016;2016:3523057. doi: 10.1155/2016/3523057.
XIII. Mulhearn B, Bruce IN. Indications for IVIG in rheumatic diseases. Rheumatology (Oxford). 2015 Mar;54(3):383-91. doi: 10.1093/rheumatology/keu429.
XIV. Kaufman GN, Massoud AH, Dembele M, et al. Induction of regulatory T cells by intravenous immunoglobulin. A bridge between adaptive and innate immunity. Front Immunol. 2015 Sep 11;6:469. doi: 10.3389/fimmu.2015.00469.
XV. Cámpora H, Falduti A. Evaluación y tratamiento de las alteraciones de la deglución. Rev Am Med Respir 2012;12(3):98-107.
XVI. Dalakas MC, Illa I, Dambrosia JM, Soueidan SA, Stein DP, Otero C, et al. A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med. 1993 Dec 30;329(27):1993-2000. doi: 10.1056/NEJM199312303292704.
XVII. Tian JGJS, Chen JW, Li F, Xie X, Du JF. Efficacy and safety of the combined treatment with intravenous immunoglobulin and oral glucocorticoid in the elderly with dermatomyositis. Chin J Geriatr. 2008;27:588-90.
XVIII. Miyasaka N, Hara M, Koike T, Saito E, Yamada M, Tanaka Y, et al. Effects of intravenous immunoglobulin therapy in Japanese patients with polymyositis and dermatomyositis resistant to corticosteroids: a randomized double-blind placebo-controlled trial. Mod Rheumatol. 2012 Jun;22(3):382-93. doi: 10.1007/s10165-011-0534-4.
XIX. Aggarwal R, Charles-Schoeman C, Schessl J, et al. Trial of intravenous immune globulin in dermatomyositis. N Engl J Med. 2022 Oct 6;387(14):1264-1278. doi: 10.1056/NEJMoa2117912.
XX. Cherin P, Piette JC, Wechsler B, et al. Intravenous gamma globulin as first line therapy in polymyositis and dermatomyositis: an open study in 11 adult patients. J Rheumatol. 1994 Jun;21(6):1092-7.
XXI. Galimberti F, Kooistra L, Li Y, et al. Intravenous immunoglobulin is an effective treatment for refractory cutaneous dermatomyositis. Clin Exp Dermatol. 2018 Dec;43(8):906-912. doi: 10.1111/ced.13607.
XXII. Genevay S, Saudan-Kister A, Guerne PA. Intravenous gammaglobulins in refractory polymyositis: lower dose for maintenance treatment is effective. Ann Rheum Dis. 2001 Jun;60(6):635-6. doi: 10.1136/ard.60.6.635.
XXIII. Marie I, Menard JF, Hatron PY, et al. Intravenous immunoglobulins for steroid-refractory esophageal involvement related to polymyositis and dermatomyositis: a series of 73 patients. Arthritis Care Res (Hoboken). 2010 Dec;62(12):1748-55. doi: 10.1002/acr.20325.
XXIV. Giannini M, Fiorella ML, Tampoia M, et al. Long-term efficacy of adding intravenous immunoglobulins as treatment of refractory dysphagia related to myositis: a retrospective analysis. Rheumatology (Oxford). 2021 Mar 2;60(3):1234-1242. doi: 10.1093/rheumatology/keaa443.
XXV. Barsotti S, Cavazzana I, Zanframundo G, Neri R, Taraborelli M, Cioffi E, et al. Real life picture of the use of intravenous immunoglobulins in idiopathic inflammatory myopathies: results of a multicentric study. Autoimmun Rev. 2021 Mar;20(3):102757. doi: 10.1016/j.autrev.2021.102757.
XXVI. Wang LM, Yang QH, Zhang L, et al. Intravenous immunoglobulin for interstitial lung diseases of anti-melanoma differentiation-associated gene 5-positive dermatomyositis. Rheumatology (Oxford). 2022 Aug 30;61(9):3704-3710. doi: 10.1093/rheumatology/keab928.
XXVII. Oldroyd AGS, Lilleker JB, Amin T, et al. British Society for Rheumatology Standards, Audit and Guidelines Working Group. British Society for Rheumatology guideline on management of paediatric, adolescent and adult patients with idiopathic inflammatory myopathy. Rheumatology (Oxford). 2022 May 5;61(5):1760-1768. doi: 10.1093/rheumatology/keac115.
XXVIII. Dalakas MC, Koffman B, Fujii M, et al. A controlled study of intravenous immunoglobulin combined with prednisone in the treatment of IBM. Neurology. 2001 Feb 13;56(3):323-7. doi: 10.1212/wnl.56.3.323.
XXIX. Wang DX, Shu XM, Tian XL, et al. Intravenous immunoglobulin therapy in adult patients with polymyositis/dermatomyositis: a systematic literature review. Clin Rheumatol. 2012 May;31(5):801-6. doi: 10.1007/s10067-012-1940-5.
XXX. Anh-Tu Hoa S, Hudson M. Critical review of the role of intravenous immunoglobulins in idiopathic inflammatory myopathies. Semin Arthritis Rheum. 2017 Feb;46(4):488-508. doi: 10.1016/j.semarthrit.2016.07.014.
XXXI. Danieli MG, Tonacci A, Paladini A, et al. A machine learning analysis to predict the response to intravenous and subcutaneous immunoglobulin in inflammatory myopathies. A proposal for a future multi-omics approach in autoimmune diseases. Autoimmun Rev. 2022 Jun;21(6):103105. doi: 10.1016/j.autrev.2022.103105.
Publicado
2025-03-29
Cómo citar
1.
Medina GA, Muñoz Torres C, Ortuño Lobo RG, López I. Inmunoglobulinas intravenosas en pacientes hospitalizados con miopatía inflamatoria idiopática. Rev. Argent. Reumatol. [Internet]. 29 de marzo de 2025 [citado 23 de junio de 2025];36(1):11 -7. Disponible en: https://ojs.reumatologia.org.ar/index.php/revistaSAR/article/view/918
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Derechos de autor 2025 a nombre de los autores. Derechos de reproducción: Sociedad Argentina de Reumatología
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