ROLE OF INTRAVENOUS IMMUNOGLOBULINS IN THE TREATMENT OF SMALL FIBER NEUROPATHY
- Nataliya Gavrilova (Basantsova), Russian Federation
Abstract
Background and Aims
Small fiber neuropathy (SFN) is a dysfunction of the nerve fibers A delta and C type. The main clinical symptoms include permanent burning pain and dysautonomia. SFN can be a cytokine-mediated complication of autoimmune diseases, the presence of autoantibodies to acetylcholine and adrenoreceptors is also observed in several cases (Ryabkova V.A. et al, 2019).
Methods
Treatment options and IVIG. In the presence of pain, steroid therapy is generally prescribed, but another immunological treatment such as chimeric monoclonal antibodies, anti-TNF and intravenous immunoglobulins (IVIG) is under study. For a long time, only individual clinical cases on SFN treatment with IVIG were published, while systematic analyses were not performed. In 2018, Liu and Schofield separately reported 2 large retrospective case series with similar response rates of approximately 80% (Liu et al, 2018, Shoefeld et al, 2018).
Results
Improvement in the IVIG therapy usually slowly continues over 6–12 months and may continue for up to 2 years. The most common side effects of IVIG are aseptic meningitis, severe headaches, and thrombosis especially when the therapy is dosed in the traditional way 1–2 g/kg over 2–5 days. The limitations of therapy include lack of approval of IVIG prescription for SFN, a small number of randomized studies and the high cost of medication.
Conclusions
Conclusion. IVIG may be a perspective treatment option in patients with autoimmune SFN. Further studies are required to clarify the indications, dosing regimen and the approval of this therapy for clinical practice.