TY - JOUR
T1 - Clinical factors influencing the response to intravenous immunoglobulin treatment in cases of treatment-resistant pyoderma gangrenosum
AU - Haag, Carter K.
AU - Ortega-Loayza, Alex G.
AU - Latour, Emile
AU - Keller, Jesse J.
AU - Fett, Nicole M.
N1 - Publisher Copyright:
© 2019 Taylor & Francis Group, LLC.
PY - 2020/10/2
Y1 - 2020/10/2
N2 - Background: Pyoderma gangrenosum (PG) is a neutrophilic disorder which classically presents as chronic, painful ulcers on the lower extremities. There is evidence supporting a potential role for intravenous immunoglobulin (IVIG) as adjuvant therapy for treatment-resistant cases; however, it is unclear which patients will most benefit from this modality of treatment–an especially important consideration given the cost per infusion ($5000–$10,000). Thus, we sought to identify the clinical characteristics of patients with refractory PG lesions who demonstrated complete healing when IVIG was incorporated into the therapeutic plan. Methods: We performed a literature search of PubMed/MEDLINE and Embase using the keywords ‘pyoderma gangrenosum’ and ‘IVIG’. We also added four institutional cases. Descriptive statistics were used to analyze the data. Significance was set at p <.05. Results: We discovered a total of 45 cases. Twenty-three patients with treatment-resistant PG had complete healing, 22 had partial or unhealed PG ulcers. Patients with one ulcer were 4.1 (95% CI: 1.1–18.5) times more likely to achieve complete healing than patients with more than one ulcer, when IVIG was added (p =.041). Conclusion: There is increased efficacy of IVIG as a treatment for patients with a solitary treatment-resistant PG lesion compared to patients with multiple refractory lesions.
AB - Background: Pyoderma gangrenosum (PG) is a neutrophilic disorder which classically presents as chronic, painful ulcers on the lower extremities. There is evidence supporting a potential role for intravenous immunoglobulin (IVIG) as adjuvant therapy for treatment-resistant cases; however, it is unclear which patients will most benefit from this modality of treatment–an especially important consideration given the cost per infusion ($5000–$10,000). Thus, we sought to identify the clinical characteristics of patients with refractory PG lesions who demonstrated complete healing when IVIG was incorporated into the therapeutic plan. Methods: We performed a literature search of PubMed/MEDLINE and Embase using the keywords ‘pyoderma gangrenosum’ and ‘IVIG’. We also added four institutional cases. Descriptive statistics were used to analyze the data. Significance was set at p <.05. Results: We discovered a total of 45 cases. Twenty-three patients with treatment-resistant PG had complete healing, 22 had partial or unhealed PG ulcers. Patients with one ulcer were 4.1 (95% CI: 1.1–18.5) times more likely to achieve complete healing than patients with more than one ulcer, when IVIG was added (p =.041). Conclusion: There is increased efficacy of IVIG as a treatment for patients with a solitary treatment-resistant PG lesion compared to patients with multiple refractory lesions.
KW - Pyoderma gangrenosum
KW - immunosuppressive medications
KW - intravenous immunoglobulin
KW - neutrophilic dermatoses
KW - treatment-resistant pyoderma gangrenosum
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U2 - 10.1080/09546634.2019.1606888
DO - 10.1080/09546634.2019.1606888
M3 - Article
C2 - 30998080
AN - SCOPUS:85065438498
SN - 0954-6634
VL - 31
SP - 723
EP - 726
JO - Journal of Dermatological Treatment
JF - Journal of Dermatological Treatment
IS - 7
ER -