Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

The findings of controlled trials on use of intravenous immunoglobulin G (IV IgG) to treat myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are generally viewed as representing mixed results. On detailed review, a clearer picture emerges, which suggests that the potential therapeutic valu...

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Autores principales:	Helen Brownlie, Nigel Speight
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	immunoglobulin myalgic encephalomyelitis chronic fatigue syndrome viral onset cell-mediated immunity post-acute sequelae of COVID-19 Medicine R
Acceso en línea:	https://doaj.org/article/ab8421a21c224c2bb2809c66dc7d4aa8
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spelling	oai:doaj.org-article:ab8421a21c224c2bb2809c66dc7d4aa82021-11-25T17:46:00ZBack to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome10.3390/healthcare91115462227-9032https://doaj.org/article/ab8421a21c224c2bb2809c66dc7d4aa82021-11-01T00:00:00Zhttps://www.mdpi.com/2227-9032/9/11/1546https://doaj.org/toc/2227-9032The findings of controlled trials on use of intravenous immunoglobulin G (IV IgG) to treat myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are generally viewed as representing mixed results. On detailed review, a clearer picture emerges, which suggests that the potential therapeutic value of this intervention has been underestimated. Our analysis is consistent with the propositions that: (1) IgG is highly effective for a proportion of patients with severe and well-characterised ME/CFS; (2) responders can be predicted with a high degree of accuracy based on markers of immune dysfunction. Rigorous steps were taken in the research trials to record adverse events, with transient symptom exacerbation commonly experienced in both intervention and placebo control groups, suggesting that this reflected the impact of participation on people with an illness characterised by post-exertional symptom exacerbation. Worsening of certain specific symptoms, notably headache, did occur more commonly with IgG and may have been concomitant to effective treatment, being associated with clinical improvement. The findings emerging from this review are supported by clinical observations relating to treatment of patients with severe and very severe ME/CFS, for whom intramuscular and subcutaneous administration provide alternative options. We conclude that: (1) there is a strong case for this area of research to be revived; (2) pending further research, clinicians would be justified in offering a course of IgG to selected ME/CFS patients at the more severe end of the spectrum. As the majority of trial participants had experienced an acute viral or viral-like onset, we further suggest that IgG treatment may be pertinent to the care of some patients who remain ill following infection with SARS-CoV-2 virus.Helen BrownlieNigel SpeightMDPI AGarticleimmunoglobulinmyalgic encephalomyelitischronic fatigue syndromeviral onsetcell-mediated immunitypost-acute sequelae of COVID-19MedicineRENHealthcare, Vol 9, Iss 1546, p 1546 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	immunoglobulin myalgic encephalomyelitis chronic fatigue syndrome viral onset cell-mediated immunity post-acute sequelae of COVID-19 Medicine R
spellingShingle	immunoglobulin myalgic encephalomyelitis chronic fatigue syndrome viral onset cell-mediated immunity post-acute sequelae of COVID-19 Medicine R Helen Brownlie Nigel Speight Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
description	The findings of controlled trials on use of intravenous immunoglobulin G (IV IgG) to treat myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are generally viewed as representing mixed results. On detailed review, a clearer picture emerges, which suggests that the potential therapeutic value of this intervention has been underestimated. Our analysis is consistent with the propositions that: (1) IgG is highly effective for a proportion of patients with severe and well-characterised ME/CFS; (2) responders can be predicted with a high degree of accuracy based on markers of immune dysfunction. Rigorous steps were taken in the research trials to record adverse events, with transient symptom exacerbation commonly experienced in both intervention and placebo control groups, suggesting that this reflected the impact of participation on people with an illness characterised by post-exertional symptom exacerbation. Worsening of certain specific symptoms, notably headache, did occur more commonly with IgG and may have been concomitant to effective treatment, being associated with clinical improvement. The findings emerging from this review are supported by clinical observations relating to treatment of patients with severe and very severe ME/CFS, for whom intramuscular and subcutaneous administration provide alternative options. We conclude that: (1) there is a strong case for this area of research to be revived; (2) pending further research, clinicians would be justified in offering a course of IgG to selected ME/CFS patients at the more severe end of the spectrum. As the majority of trial participants had experienced an acute viral or viral-like onset, we further suggest that IgG treatment may be pertinent to the care of some patients who remain ill following infection with SARS-CoV-2 virus.
format	article
author	Helen Brownlie Nigel Speight
author_facet	Helen Brownlie Nigel Speight
author_sort	Helen Brownlie
title	Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
title_short	Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
title_full	Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
title_fullStr	Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
title_full_unstemmed	Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
title_sort	back to the future? immunoglobulin therapy for myalgic encephalomyelitis/chronic fatigue syndrome
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/ab8421a21c224c2bb2809c66dc7d4aa8
work_keys_str_mv	AT helenbrownlie backtothefutureimmunoglobulintherapyformyalgicencephalomyelitischronicfatiguesyndrome AT nigelspeight backtothefutureimmunoglobulintherapyformyalgicencephalomyelitischronicfatiguesyndrome
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Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

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