Intravenous Immunoglobulin Therapy for Pyoderma Gangrenosum: A Multicenter Retrospective Analysis in 81 Patients
Ronicke M, Sollfrank L, Vitus MV, Walter LJ, Krieter M, Moelleken M, Dissemond J, Schultz E, Lauffer F, von den Driesch P, Erfurt-Berge C
Publication Type: Journal article
Journal
DOI: 10.1007/s40257-024-00904-w
Abstract
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: (Figure presented.)
Authors with CRIS profile
Moritz Ronicke
Department of Dermatology
Lukas Sollfrank
Department of Dermatology
Cornelia Erfurt-Berge
Department of Dermatology
Involved external institutions
Paracelsus Medizinische Privatuniversität, Nürnberg
Germany (DE)
Universitätsklinikum Essen
Germany (DE)
Technische Universität München (TUM)
Germany (DE)
Klinikum Stuttgart
Germany (DE)
Germany (DE)
Universitätsklinikum Essen
Germany (DE)
Technische Universität München (TUM)
Germany (DE)
Klinikum Stuttgart
Germany (DE)
How to cite
APA:
Ronicke, M., Sollfrank, L., Vitus, M.V., Walter, L.J., Krieter, M., Moelleken, M.,... Erfurt-Berge, C. (2024). Intravenous Immunoglobulin Therapy for Pyoderma Gangrenosum: A Multicenter Retrospective Analysis in 81 Patients. American Journal of Clinical Dermatology. https://doi.org/10.1007/s40257-024-00904-w
MLA:
Ronicke, Moritz, et al. "Intravenous Immunoglobulin Therapy for Pyoderma Gangrenosum: A Multicenter Retrospective Analysis in 81 Patients." American Journal of Clinical Dermatology (2024).
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