Abstract
INTRODUCTION: intravenous immunoglobulin (IVIg) has gained acceptance as an alternative treatment in several neurological diseases of the central and peripheral nervous system. Wherever available its’ use should be rationalized to those diseases in which the clinical efficacy has been demonstrated.
OBJECTIVES: to generate evidence based recommendations from randomized clinical trials (RCT) for the use of IVIg.
METHODS: a systematic search of RCTs was performed using Medline, Ovid, Science Direct, Hinari and Cochrane databases. A total of 189 titles were initially obtained from which pertinent RCTs where selected.
RESULTS. sixty RCT’s where systematically reviewed. At the end, 45 RCT’s and 5 Cochrane systematic reviews where used to produce the present recommendations of IVIg use in 11 distinct neurological diseases.
CONCLUSIONS: the benefit of IVIg over placebo is supported by evidence provided by at least two RCTs with converging results in: Remitting and recurring multiple sclerosis, child Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. The benefit of IVIg is at least as effective as plasma exchange in adult Guillain-Barré syndrome. The benefit of IVIg is also discussed for evidence based on single RCT results, RCTs with methodological drawbacks and RCTs with no demonstrable benefit.
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