Guía colombiana de práctica clínica para el uso de inmonuglobulinas en el tratamiento de reemplazo e inmunomodulación

María Margarita Olivares, Carlos E. Olmos, Martha I. Álvarez, Adriana María Fajardo, Andrés Felipe Zea-Vera, María Claudia Ortega, Diego Medina, Pahola Marcela Pérez, Delbert Giovanny Beltrán, Beatriz Duque, Carlos Arturo Álvarez, Germán Lenis, Juan Marcos Solano, Diana Gómez, José Luis Franco, María Claudia Díaz, Julio César Orrego, Margarita María Velásquez, Mauricio Chaparro, Jessica Liliana Pinto, Óscar Ramírez, Álvaro Izquierdo, Sergio Francisco Ramírez

Resumen


Las inmunoglobulinas son proteínas heterodiméricas compuestas de 2 cadenas pesadas y 2 cadenas ligeras. La inmunoglobulina G humana es un derivado del plasma y contiene más de 95 % de IgG. La composición de las subclases de IgG es similar a la del plasma humano normal. El tratamiento con inmunoglobulina comenzó hace más de 50 años y su uso se ha descrito en numerosas enfermedades. En Colombia, la importancia de este recurso inmunomodulador condujo a la necesidad de contar con una guía de práctica clínica para su uso, para lo cual se reunió un grupo multidisciplinario de expertos, quienes se distribuyeron en mesas de trabajo, por especialidad, para redactar un texto base. Se llevaron a cabo búsquedas bibliográficas sistemáticas; las evidencias identificadas se valoraron y clasificaron para sustentar un texto preliminar que fue discutido, analizado y corregido. Se emitieron recomendaciones de uso de la inmunoglobulina intravenosa en patologías que abarcan inmunodeficiencias primarias y secundarias, enfermedades autoinmunes, alteraciones neurológicas, infecciones, trasplantes y enfermedades misceláneas; se asignaron calificaciones según el sistema GRADE para cada una. El resultado final se tradujo en las recomendaciones que se presentan con la finalidad de informar, orientar y apoyar en el uso óptimo de dicho recurso inmunomodulador.


Palabras clave


Inmunoglobulina; Inmunomodulación; Guías de práctica clínica

Texto completo:

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Referencias


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Winston DJ, Antin JH, Wolff SN, Bierer BE, Small T, Miller KB, et al. A multicenter, randomized, double-blind comparison of different doses of intravenous immunoglobulin for prevention of graft-versus-host disease and infection after allogeneic bone marrow transplantation. Bone Marrow Transplant. 2001;28(2):187-196. DOI: http://dx.doi.org/10.1038/sj.bmt.1703109

Leffell J, Jones RJ, Gladstone DE. Donor HLA-specific Abs: To BMT or not to BMT? Bone Marrow Transplant. 2015,50(6):751-758. DOI: http://dx.doi.org/10.1038/bmt.2014.331

Huang YC, Chien YN, Chen YT, LI YC, Chen TJ. Intravenous immunoglobulin for the treatment of toxic epidermal necrolysis: A systematic review and meta-analysis. G Ital Dermatol Venereol. 2016;151(5):515-524.

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CENETEC. Guía de referencia rápida. Diagnóstico y tratamiento del síndrome de Stevens-Johnson/necrólisis epidérmica tóxica en el adulto. México: Secretaría de Salud; 2010. Disponible en: http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/398_GPC_Diagnostico_tratamiento_SINDROME_STEVENS_JOHNSON/GRR_STEVENS_JONSON.pdf

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Jee SJ, Kim JH, Baek HS, Lee HB, Oh JW. Long Term efficacy on intraglobulin therapy for moderate to severe childhood atopic dermatitis. Allergy Asthma Immunol Res. 2011;3(2):88-95. DOI: http://dx.doi.org/10.4168/aair.2011.3.2.89

Crowe BH, Salt AT. Autism: The management and support of children and young people on the autism spectrum (NICE Clinical Guideline 170). Arch Dis Child Educ Pract Ed. 2015;100(1):20-23. DOI: http://dx.doi.org/10.1136/archdischild-2013-305468

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Vollmer-Conna U, Hickie I, Hadzi-Pavlovic D, Tymms K, Wakefield D, Dwyer J, et al. Intravenous immunoglobulin is ineffective in the treatment of patients with chronic fatigue syndrome. Am J Med. 1997;103(1):38-43. DOI: http://dx.doi.org/10.1016/S0002-9343(97)90045-0

Balfour-Lynn IM, Mohan U, Bush A, Rosenthal M. Intravenous immunoglobulin for cystic fibrosis lung disease: A case series of 16 children. Arch Dis Child. 2004;89(4):315-319. DOI: http://dx.doi.org/10.1136/adc.2003.026575

Ortega-López MC, Escobar-Quintero A, Barrero-Miranda DC. Basal serum levels of immunoglobulins G, A, M, and E in the group of patients with cystic fibrosis at Hospital Infantil Universitario de San José Bogotá DC, in 2014. Alergia e Inmunol Pediatr. 2016;25(2):38-45. Disponible en: http://www.medigraphic.com/pdfs/alergia/al-2016/al162b.pdf

Robinson J, Hartling L, Vandermeer B, Klassen TP. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev. 2015;(5):CD004370. DOI: http://dx.doi.org/10.1002/14651858.CD004370.pub3

Maisch B, Pankuweit S. Standard and etiology-directed evidence-based therapies in myocarditis: State of the art and future perspectives. Heart Fail Rev. 2013;18(6):761-795. DOI: http://dx.doi.org/10.1007/s10741-012-9362-7

Bhatt GC, Sankar J, Kushwaha KP. Use of intravenous immunoglobulin compared with standard therapy is associated with improved clinical outcomes in children with acute encephalitis syndrome complicated by myocarditis. Pediatr Cardiol. 2012;33(8):1370-1376. DOI: http://dx.doi.org/10.1007/s00246-012-0350-4

Stephenson MD, Kutteh WH, Purkiss S, Librach C, Schultz P, Houlihan E, et al. Intravenous immunoglobulin and idiopathic secondary recurrent miscarriage: A multicentered randomized placebo-controlled trial. Hum Reprod. 2010;25(9):2203-2209. DOI: http://dx.doi.org/10.1093/humrep/deq179

Ata B, Tan SL, Shehata F, Holzer H, Buckett W. A systematic review of intravenous immunoglobulin for treatment of unexplained recurrent miscarriage. Fertil Steril. 2011;95(3):1080-1085. DOI: http://dx.doi.org/10.1016/j.fertnstert.2010.12.021


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