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

Carter K. Haag, Alex Ortega Loayza, Emile Latour, Jesse J. Keller, Nicole Fett

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalJournal of Dermatological Treatment
DOIs
StatePublished - Jan 1 2019

Fingerprint

Pyoderma Gangrenosum
Intravenous Immunoglobulins
Ulcer
Therapeutics
PubMed
MEDLINE
Lower Extremity
Costs and Cost Analysis

Keywords

  • immunosuppressive medications
  • intravenous immunoglobulin
  • neutrophilic dermatoses
  • Pyoderma gangrenosum
  • treatment-resistant pyoderma gangrenosum

ASJC Scopus subject areas

  • Dermatology

Cite this

@article{d0b76b629d6247a2868cdc8e1f99943e,
title = "Clinical factors influencing the response to intravenous immunoglobulin treatment in cases of treatment-resistant pyoderma gangrenosum",
abstract = "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.",
keywords = "immunosuppressive medications, intravenous immunoglobulin, neutrophilic dermatoses, Pyoderma gangrenosum, treatment-resistant pyoderma gangrenosum",
author = "Haag, {Carter K.} and {Ortega Loayza}, Alex and Emile Latour and Keller, {Jesse J.} and Nicole Fett",
year = "2019",
month = "1",
day = "1",
doi = "10.1080/09546634.2019.1606888",
language = "English (US)",
journal = "Journal of Dermatological Treatment",
issn = "0954-6634",
publisher = "Informa Healthcare",

}

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

AU - Latour, Emile

AU - Keller, Jesse J.

AU - Fett, Nicole

PY - 2019/1/1

Y1 - 2019/1/1

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 - immunosuppressive medications

KW - intravenous immunoglobulin

KW - neutrophilic dermatoses

KW - Pyoderma gangrenosum

KW - treatment-resistant pyoderma gangrenosum

UR - http://www.scopus.com/inward/record.url?scp=85065438498&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065438498&partnerID=8YFLogxK

U2 - 10.1080/09546634.2019.1606888

DO - 10.1080/09546634.2019.1606888

M3 - Article

JO - Journal of Dermatological Treatment

JF - Journal of Dermatological Treatment

SN - 0954-6634

ER -