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Intravenous immunoglobulin for multifocal motor neuropathy

  • Review
  • Intervention

Authors


Abstract

Background

Multifocal motor neuropathy is a rare, probably immune mediated disorder characterised by slowly progressive, asymmetric, distal weakness of one or more limbs with no objective loss of sensation. It may cause prolonged periods of disability. The treatment options for multifocal motor neuropathy are sparse. Patients with multifocal motor neuropathy do not usually respond to steroids or plasma exchange, and may even worsen with these treatments. Many uncontrolled studies have suggested a beneficial effect of intravenous immunoglobulin.

Objectives

To review systematically the evidence from randomised controlled trials concerning the efficacy and safety of intravenous immunoglobulin in multifocal motor neuropathy.

Search methods

We used the search strategy of the Cochrane Neuromuscular Disease Review Group to search the Disease Group register (searched March 2007), MEDLINE (January 1990 to March 2007), EMBASE (January 1990 to March 2007) and ISI (January 1990 to March 2007) databases for randomised controlled trials.

Selection criteria

Randomised controlled studies examining the effects of any dose of intravenous immunoglobulin versus placebo in patients with definite or probable multifocal motor neuropathy.
Outcome measures had to include one of the following: disability, strength, or conduction block. Studies which reported the frequency of adverse effects were used to assess safety.

Data collection and analysis

Two authors reviewed literature searches to identify potentially relevant trials, scored their quality and extracted data independently. For dichotomous data, we calculated relative risks, and for continuous data, effect sizes and weighted pooled effect sizes. Statistical uncertainty was expressed with 95% confidence intervals.

Main results

Four randomised controlled trials including a total of 34 patients were suitable for this systematic review. Strength improved in 78% of patients treated with intravenous immunoglobulin and only 4% of placebo-treated patients. Disability improved in 39% of patients after intravenous immunoglobulin treatment and in 11% after placebo (statistically not significantly different). Mild, transient side effects were reported in 71% of intravenous immunoglobulin treated patients. Serious side effects were not encountered.

Authors' conclusions

Limited evidence from randomised controlled trials shows that intravenous immunoglobulin has a beneficial effect on strength. There was a non-significant trend towards improvement in disability. More research is needed to discover whether intravenous immunoglobulin improves disability and is cost-effective.

摘要

背景

靜脈注射免疫球蛋白療法對於多處局部運動神經病變

多處局部運動神經病變是一種少見的可能為免疫誘發的疾病,特徵為緩慢進行非對稱的一個肢體以上的遠端無力,沒有客觀上的感覺喪失,可能造成長時間的失能,治療的選擇極少,多處局部運動神經病變病人對腎上腺皮質素或者血漿置換術的治療經常沒有反應,甚至可能在這些治療後惡化,有許多非對照試驗建議靜脈注射免疫球蛋白有效。

目標

系統性回顧關於靜脈注射免疫球蛋白對於多處局部運動神經病變的安全性及療效的隨機對照試驗

搜尋策略

我們搜尋了考科藍神經肌肉疾病回顧群組裡頭疾病群組登錄(March 2007), MEDLINE (January 1990 to March 2007), EMBASE (January 1990 to March 2007)以及 ISI 資料庫(January 1990 to March 2007)的隨機對照試驗

選擇標準

針對確定或疑似多處局部運動神經病變病人,檢驗任何劑量的靜脈注射免疫球蛋白與安慰劑的效果的隨機對照試驗,測量預後標準必須包括失能、力量或是傳導停滯,利用有報告副作用發生頻率的研究來評估安全性

資料收集與分析

二位作者獨立審閱文獻,找出相關的試驗去評斷品質及提取資料,對於二分法的資料我們計算其相對機率,對於連續性的資料則看有效資料大小及加權合併的有效大小,統計學上不確定的以95%信賴區間表示。

主要結論

文獻回顧找到了4篇隨機對照試驗共34位病人,靜脈注射免疫球蛋白治療的病人有78%力氣進步,安慰劑組則只有4%,靜脈注射免疫球蛋白治療的病人有39%失能情況改善,安慰劑組只有11%(統計學未達顯著差別),靜脈注射免疫球蛋白治療的病人有71%產生輕微副作用,沒有病人產生嚴重的副作用。

作者結論

從隨機對照試驗得到有限的證據顯示靜脈注射免疫球蛋白對於力氣恢復有幫助,在失能恢復上傾向有益但未達統計學上差別,需要更多研究證實靜脈注射免疫球蛋白是否能改善失能以及是否成本上有效。

翻譯人

本摘要由新光醫院吳亞縈翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

靜脈注射免疫球蛋白比起安慰劑更有助於力氣恢復,多處局部運動神經病變是一種少見的情況導致進行性的肢體無力,影響到手臂以及特別是手比腳更常見。治療多處局部運動神經病變一般使用靜脈注射免疫球蛋白(從血液純化出的抗體),從4篇隨機對照試驗證據顯示靜脈注射免疫球蛋白可明顯改善力氣,在失能恢復上也有幫助但未達統計學上意義,副作用輕微且短暫。

Plain language summary

Intravenous immunoglobulin treatment improves strength significantly more often than placebo

Multifocal motor neuropathy is a rare condition causing progressive weakness of the limbs. The arms and especially the hands, are more commonly involved than the legs. The usual treatment for multifocal motor neuropathy is infusion of immunoglobulin (antibodies purified from the blood) into a vein. Evidence from four randomised controlled trials showed that people treated with intravenous immunoglobulin had significant improvements in strength. Improvement in disability was also seen but was not significant. Side effects were common but were mild and transient.

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