Clinical factors influencing the response to intravenous immunoglobulin treatment in cases of treatment-resistant pyoderma gangrenosum

a Department of Dermatology , Oregon Health & Science University, Center for Health & Healing , 3303 SW Bond Ave. Portland , Oregon 97239 , USA. b Knight Cancer Institute, Oregon Health & Science University , 3303 SW Bond Ave. Portland , Oregon 97239 , USA.

The Journal of dermatological treatment. 2019;:1-13
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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 ($5,000-$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 < 0.05. 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 to 18.5) times more likely to achieve complete healing than patients with more than one ulcer, when IVIG was added (p = 0.041). 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.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine