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Einsatz von i. v. Immunglobulinen in der Neurologie

Evidenzbasierter Konsens

Use of IV immunoglobulins in neurology

Evidence-based consensus

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Zusammenfassung

Zu verschiedenen neurologischen Autoimmunerkrankungen gibt es für hoch dosierte i. v. Immunglobuline (IVIg) inzwischen überzeugende Ergebnisse aus den nach modernen Standards durchgeführten, plazebokontrollierten Therapiestudien. Dennoch sind sie bei neurologischen Erkrankungen lediglich für das Guillain-Barré-Syndrom zugelassen. Es muss daher ein gezielter Einsatz von IVIg gefordert werden, da eine wirksame Therapie dem Patienten nicht vorenthalten werden darf, insbesondere wenn IVIg nicht durch gleichwertige Alternativen ersetzt werden können. Die hier vorgelegte Arbeit repräsentiert und gewichtet die verfügbaren Studienergebnisse zum Einsatz von IVIg. Auf der Basis dieser Evidenz wurden Empfehlungen zur Therapie mit IVIg erarbeitet, die auf einem breiten Konsens einer international ausgewiesenen, deutschsprachigen Neurologengruppe basieren. Dadurch soll zukünftig ein gezielter Einsatz von IVIg bei neurologischen Autoimmunerkrankungen gewährleistet werden.

Summary

Intravenous immunoglobulins (IVIg) have become an alternative immunomodulatory treatment for neurological autoimmune disorders. On the basis of several well conducted placebo-controlled trials evidence is available supporting the efficacy of IVIg. However, of all neurological diseases, IVIg is currently only licensed for Guillain-Barré syndrome. Thus, the off-label use of IVIg has to be focussed although an effective treatment must be made available for the patients, in particular when there is no other treatment alternative.

The consensus paper presented here critically discusses the modern studies investigating the use of IVIg in neurological diseases. On the basis of this evidence recommendations for the treatment with IVIg were developed. To achieve a broad and valid consensus, numerous German speaking experts in the field were involved. It is expected that this manuscript will help to ascertain a rational use of IVIg in the future.

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Authors and Affiliations

  1. Neurologische Klinik, OE 7210, Medizinische Hochschule , Hannover

    M. Stangel

  2. Klinische Forschungsgruppe für Multiple Sklerose, Neurologische Klinik, Universität, Würzburg

    R. Gold (Für die IVIg Konsensusgruppe)

  3. Institut für Multiple-Sklerose-Forschung, Bereich Humanmedizin und Gemeinnützige Hertie-Stiftung , Georg-August-Universität, Göttingen

    R. Gold (Für die IVIg Konsensusgruppe)

  4. Neurologische Klinik, OE 7210, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover

    M. Stangel

Authors
  1. M. Stangel
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  2. R. Gold
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Correspondence to M. Stangel.

Additional information

Erweitertes Schreibkomitee und Mitglieder der IVIg Konsensusgruppe s. Anhang

Mitglieder der Konsensusgruppe

Mitglieder der Konsensusgruppe

Koordination und Schriftführung

  • M. Stangel, Hannover

  • R. Gold, Würzburg/Göttingen

Erweitertes Schreibkomitee

  • K. V. Toyka, Würzburg

  • H.-P. Hartung, Düsseldorf

  • R. Hohlfeld, München

PNP

  • B.C. Kieseier , Düsseldorf

  • T. Berger, Innsbruck

  • A. Czaplinski, Basel

  • H.-P. Hartung, Düsseldorf

  • R. Kiefer, Münster

  • B. Neundörfer, Erlangen

  • A. Steck, Basel

Myasthenie

  • V. Schuchardt, Lahr

  • A. Melms, Tübingen

  • K. V. Toyka, Würzburg

Myositiden

  • N. Goebels, Zürich

  • D. Pongratz, München

  • S. Zierz, Halle

Multiple Sklerose

  • F. Fazekas, Graz

  • J. Haas, Berlin

  • L. Kappos, Basel

  • P. Rieckmann, Würzburg

  • F. Zipp, Berlin

Paraneoplastische Syndrome

  • R. Voltz, München

  • W. Grisold, Wien

  • R. Hohlfeld, München

Vaskulitiden

  • A. Steinbrecher, Regensburg

  • P. Berlit, Essen

  • H. C. Diener, Essen

Epilepsie/Rasmussen-Enzephalitis

  • C. G. Bien, Bonn

  • H. Wiendl, Tübingen

Stiff-person-Syndrom, Neuromyotonie

  • H.-M. Meinck, Heidelberg

Weitere Krankheitsbilder

  • H. Tumani, Ulm

  • J. J. Archelos, Graz

  • U. Zettl, Rostock

Wirkmechanismen und Nebenwirkungen

  • M. Stangel, Hannover

  • R. Gold, Würzburg/Göttingen

Die jeweils erstgenannten, kursiven Autoren waren schriftführend für die einzelnen Krankheitsgruppen.

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Stangel, M., Gold, R. Einsatz von i. v. Immunglobulinen in der Neurologie . Nervenarzt 75, 801–816 (2004). https://doi.org/10.1007/s00115-004-1733-4

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  • DOI: https://doi.org/10.1007/s00115-004-1733-4

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