Intravenous Immunoglobulin Therapy for Pyoderma Gangrenosum: A Multicenter Retrospective Analysis in 81 Patients

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2024年11月14日

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Moritz Ronicke,
Lukas Sollfrank,
Martin V. Vitus,
Lukas J. Walter,
Manuel Krieter,
Maurice Moelleken,
Joachim Dissemond,
Erwin Schultz,
Felix Lauffer,
Peter von den Driesch,
Cornelia Erfurt-Berge

摘要

Background

Pyoderma gangrenosum (PG) is rare neutrophil skin disease causing painful, progressively enlarging ulcers. Among the treatment options, intravenous immunoglobulin (IVIG) is a therapy of first choice for paraneoplastic PG. Otherwise, it is used in therapy-refractory courses.

Objective

To assess the efficacy and safety of IVIG therapy in patients with PG.

Methods

A retrospective chart review for patients in five dermatologic wound centres in Germany was performed.

Results

Overall, 81 patients were included. IVIG was used as adjunct therapy with (methyl-) prednisolone and/or a steroid sparing therapy in 77 (95.1%) cases. Response to treatment (combined complete and partial, defined as tendency to heal and cessation of lesion progression, respectively) was 49.3% 1 month after initiation of IVIG. In total 18.8% had a complete response after 6 months. Statistically significantly higher response rates were observed in patients with diabetes mellitus and thyroid disease [odds ratio (OR) 3.49, confidence interval (CI) 1.13–10.80 and OR 6.64, CI 1.01–43.57, respectively]. Patients with solid malignancy tended to have better response (OR 4.36, CI 0.79–23.91). A higher IVIG dose was also associated with a tendency towards better response rates (OR 2.70, CI 0.84–8.63). In total, 1 (1.2%) severe adverse event (myocardial infarction with consequent death) was observed as well as three moderate adverse events, with two thromboembolic events (2.5%) and one acute kidney injury (1.2%). Other adverse events were mild or unlikely to be associated with IVIG therapy, with 14 events in 10 patients overall (12.3%).

Conclusions

This multicentre retrospective study shows the important role of adjunctive IVIG therapy in patients with PG with recalcitrant courses. Identifying subgroups with a higher probability of response could improve future response rates and save patients from ineffective treatment and potential adverse events.

Graphical Abstract