The effect of intravenous immunoglobulin on neuromyelitis optica

Abstract Objective Evaluate safety and tolerance levels for intravenous immunoglobulins (IVIG) as treatment for neuromyelitis optica (NMO). Methods Eight patients meeting Wingerchuk's revised diagnostic criteria were treated with IVIG every 2 months (0.7 g/kg body weight per day for 3 days). The primary outcome measure was the occurrence of serious adverse effects, defined according to NIH guidelines for clinical trials. Secondary outcome measures were changes in the yearly rate of attacks and in the degree of neurological disability measured with the Expanded Disability Status Scale (EDSS). Results All 8 patients were treated; 5 had relapsing optic neuritis with or without myelitis and 3 had recurrent longitudinally extensive transverse myelitis (LETM). The mean age of onset was 20.5 years (range, 7–31 years) and 87.5% were female. The mean duration of the disease before beginning treatment was 9.0 years (range, 3–17 years). Following 83 infusions (range, 4–21 per patient) and a mean follow-up time of 19.3 months (range, 6–39 months), minor adverse events had occurred (headache in 3 patients and a mild cutaneous eruption in a single patient). The relapse rate decreased from 1.8 in the previous year to 0.006 during follow-up ( z  = −2.5, P  = .01). The EDSS score fell from 3.3 [SD 1.3] to 2.6 [SD 1.5] ( z  = −2.0, P  = .04). Conclusions Treatment with IVIG is safe and well-tolerated, and it may be used as a treatment alternative for NMO spectrum disorders.