- What is the clinical effectiveness of the off-label use of intravenous or subcutaneous immunoglobulin for the treatment of dermatological conditions?
The literature search identified evidence regarding the comparative clinical effectiveness of IVIG versus supportive care, corticosteroid treatment, or placebo, on dermatological conditions such as Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), polymyositis (PM), dermatomyositis (DM), bullous pemphigoid (BP), and systemic sclerosis (SS). In general, evidence on IVIG use for dermatological conditions is scarce and based mainly on reviews of non-randomized studies and small-sized RCTs. The results should be interpreted with caution given the strength of the evidence and the heterogeneity among the included studies.For patients with SJS and/or TEN, treatment with IVIG - alone or combined with corticosteroids did not have survival benefit compared to no-IVIG treatment, but there may be a positive correlation between high IVIG dosage and clinical benefits such as mortality rate and recovery time. Pediatric patients treated with IVIG seemed to have lower mortality than adults. For PM and/or DM, IVIG combined with corticosteroid improved muscle strength and improved biochemical profile compared to placebo or corticosteroid alone, while IVIG alone did not seem to have any impact compared to placebo. For BP, there was a statistically significant decrease in the time required until treatment reduction in the IVIG group compared to the placebo group. For SJS/TEN, PM/DM and BP, treatment with IVIG was based on one course of treatment. For SS, there was no statistically significant difference in skin thickness between the IVIG group and the placebo group after one course of treatment, while the difference was statistically significant in favour of IVIG after two courses of treatment. No study involving subcutaneous immunoglobulin met the inclusion criteria for this report