Open-Label Trial of High-Dose Intravenous Immunoglobulin in Patients with Severe Asthma

Abstract

Anti-inflammatory corticosteroid therapy is highly effective, however, the long term adverse effects may be devastating for patients with severe asthma. Intravenous immunoglobulin (IVIG) is known to have immunomodulatory effects, and in a few clinical trials has been shown to have potential benefit as a steroid-sparing agent in asthma patients requiring high doses of corticosteroids. This study assessed the efficacy of high-dose IVIG in reducing the steroid requirement and subsequently improving the pulmonary function, symptomatology, and quality of life in patients with severe steroid-dependent asthma. Six immunocompetent, steroid-dependent patients were enrolled in an open-label trial of IVIG given as six monthly infusions of 2 g/kg per dose. Five patients completed the study. Of these, four showed a significant reduction in oral corticosteroid requirement while being treated with IVIG. The mean reduction was 10.1 mg/d (p = 0.02), which was an almost 50% decrease in corticosteroid requirement. Two patients were able to completely discontinue oral corticosteroids by the end of the study. The remaining subjects were maintained on the same dose of inhaled corticosteroid throughout the study, as well as any other comedication. The forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), and peak expiratory flow rate (PEFR) showed improvement in all but one patient, but these did not reach statistical significance. Patients reported an overall improvement in quality of life. There were no significant adverse effects noted during the treatment period. High-dose IVIG may be beneficial as a steroid-sparing agent in the population of patients with severe steroid-dependent asthma.