The effect on MRI of gammaglobulin treatment in relapsing multiple sclerosis

A number of uncontrolled studies and randomised, placebo-controlled trials have shown that treatment with intravenous gammaglobulin (IVIG) reduces the exacerbation rate in relapsing multiple sclerosis (MS). Two randomised studies from Denmark and Israel, respectively have used MRI as efficacy endpoint. In a Danish crossover trial, the number of gadolinium-enhancing lesions in serial cranial MRI was significantly reduced by approximately 60% during IVIG treatment compared to placebo. Neither the Danish study nor an Israeli study were able to show significant reductions in the total lesion load on T2-weighted cranial MRI. However, the studies were either too short or comprised too few patients for showing significant differences in T2-weighted MRI. In conclusion, IVIG is of benefit to patients with relapsing MS, but larger studies are required before the place of IVIG in the treatment of MS can be established.