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Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis

BACKGROUND: Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) admini...

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Autores principales: Huang, Yao-Hsien, Chen, Hung-Chou, Huang, Kuang-Wei, Chen, Po-Chih, Hu, Chaur-Jong, Tsai, Chin-Piao, Tam, Ka-Wai, Kuan, Yi-Chun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379590/
https://www.ncbi.nlm.nih.gov/pubmed/25886512
http://dx.doi.org/10.1186/s12883-015-0301-9
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author Huang, Yao-Hsien
Chen, Hung-Chou
Huang, Kuang-Wei
Chen, Po-Chih
Hu, Chaur-Jong
Tsai, Chin-Piao
Tam, Ka-Wai
Kuan, Yi-Chun
author_facet Huang, Yao-Hsien
Chen, Hung-Chou
Huang, Kuang-Wei
Chen, Po-Chih
Hu, Chaur-Jong
Tsai, Chin-Piao
Tam, Ka-Wai
Kuan, Yi-Chun
author_sort Huang, Yao-Hsien
collection PubMed
description BACKGROUND: Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial. METHODS: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels. RESULTS: We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = −1.02, 95% confidence interval [CI] = −2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI −0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity. CONCLUSION: The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.
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spelling pubmed-43795902015-04-01 Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis Huang, Yao-Hsien Chen, Hung-Chou Huang, Kuang-Wei Chen, Po-Chih Hu, Chaur-Jong Tsai, Chin-Piao Tam, Ka-Wai Kuan, Yi-Chun BMC Neurol Research Article BACKGROUND: Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial. METHODS: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels. RESULTS: We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = −1.02, 95% confidence interval [CI] = −2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI −0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity. CONCLUSION: The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials. BioMed Central 2015-03-22 /pmc/articles/PMC4379590/ /pubmed/25886512 http://dx.doi.org/10.1186/s12883-015-0301-9 Text en © Huang et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Huang, Yao-Hsien
Chen, Hung-Chou
Huang, Kuang-Wei
Chen, Po-Chih
Hu, Chaur-Jong
Tsai, Chin-Piao
Tam, Ka-Wai
Kuan, Yi-Chun
Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
title Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
title_full Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
title_fullStr Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
title_full_unstemmed Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
title_short Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
title_sort intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379590/
https://www.ncbi.nlm.nih.gov/pubmed/25886512
http://dx.doi.org/10.1186/s12883-015-0301-9
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