Immunoglobulin Use for the Management of Painful Peripheral Neuropathy: A Systematic Review and Meta-Analysis

Panagiotis Zis; Andreas Liampas; Theodora Pozotou; Konstantinos Parperis; Artemios Artemiadis; Georgios Hadjigeorgiou

doi:10.1007/s40122-022-00416-7

Immunoglobulin Use for the Management of Painful Peripheral Neuropathy: A Systematic Review and Meta-Analysis

Pain Ther. 2022 Dec;11(4):1219-1227. doi: 10.1007/s40122-022-00416-7. Epub 2022 Aug 4.

Authors

Panagiotis Zis^{1

2}, Andreas Liampas³, Theodora Pozotou³, Konstantinos Parperis^{4

5}, Artemios Artemiadis⁴, Georgios Hadjigeorgiou⁴

Affiliations

¹ Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece. takiszis@gmail.com.
² Medical School, University of Cyprus, Nicosia, Cyprus. takiszis@gmail.com.
³ Department of Neurology, Nicosia New General Hospital, Nicosia, Cyprus.
⁴ Medical School, University of Cyprus, Nicosia, Cyprus.
⁵ Division of Rheumatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA.

Abstract

Background: Immunoglobulins (IG) are widely used for the treatment of a variety of immune-mediated diseases. The exact mechanism of action remains unknown, but IG modulate the expression and function of Fc receptors, interfere with complement activation and production of cytokines, neutralize pathogenic autoantibodies, and affect the activation and effector functions of B and T lymphocytes. Immunoglobulins are usually delivered intravenously, and are effective in ameliorating motor symptoms, and/or preventing disease progression in immune-mediated neuropathies, including Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy.

Objective: The aim of this systematic review and meta-analysis was to study the potential of IG for the treatment of painful peripheral neuropathy (PPN). The outcome of interest was the percentage of patients with PPN who achieved pain relief following IG administration.

Methods: We performed a systematic literature search on March 17, 2022, in the PubMed database without any publication date restrictions. We also looked for unpublished or ongoing trials in clinicaltrials.org. Pain reduction following IG treatment had to be within the aims (primary or secondary).

Results: The aforementioned literature search strategy revealed five studies (two open-label, three randomized placebo-controlled) eligible to be included. The pooled estimate of the percentage of patients with PPN who received immunoglobulins and reported pain relief was found to be 65% (95% CI 58-71%). The likelihood of achieving pain relief with immunoglobulin treatment was 2.9 times higher (95% CI 1.6-5.2) compared to placebo (p = 0.0003).

Conclusion: The use of IG for the treatment of pain due to peripheral neuropathy has a potential therapeutic benefit. Further studies across patients with different types of painful peripheral neuropathy are needed to better characterize this effect. Registration number on PROSPERO: CRD42022319614.

Keywords: Chronic inflammatory demyelinating polyneuropathy (CIDP); Guillain–Barré syndrome (GBS); Intravenous immunoglobulin (IVIG); Management; Pain; Peripheral neuropathy; Subcutaneous immunoglobulin (SCIG).