No effect of IVIG in secondary progressive MS

IVIG has no persistent immunomodulatory effect and does not influence clinical outcome in secondary progressive MS, according to a German study.The study was conducted to investigate the effect of IVIG on long-term cytokine production in patients treated for 24 months. IVIG has been shown to reduce MS disease activity, and the investigators hypothesised that the underlying mechanism involves modulation of cytokine profiles to induce a shift towards anti-inflammatory cytokines. A total of 34 patients with secondary progressive MS were randomised to monthly IVIG or placebo for two years. Over the treatment period, relapse rates, mean EDSS scores, and cytokine production (IFN gamma, TNF, IL-4 & IL-10) were measured. Against their expectations, the investigators found IVIG had no effect on relapse rates or disability progression and did not induce a shift towards anti-inflammatory cytokine production. In fact, the data showed that pro-inflammatory cytokines (IFN gamma and TNF) tended to increase over time in both treatments.The data is in line with results of the larger ESIMS trial, from which the patients for the current trial were drawn. However, they are in contrast to other studies in relapsing-remitting MS patients where IVIG has been shown to substantially reduce EDSS scores. The authors suggest, "One explanation may be that IVIG is more effective in the RR disease compared to SPMS due to different pathological mechanisms in the respective disease phase." The authors refer to a recent study with IFNa that showed disappointing results in patients with secondary progressive MS, despite the well-known positive results in relapsing remitting disease. They say that both the IVIG and the IFNa data "?implicate that the pathological process differs in the relapsing and the progressive phase of the disease and as a consequence distinct treatment strategies for MS are required depending on the disease phase."Reference...