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Many different effects of <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> have been demonstrated <jats:italic>in vitro<\/jats:italic>, but few studies actually identify the mechanism(s) most important <jats:italic>in vivo<\/jats:italic>. Doses and treatment intervals are generally chosen empirically. Recent studies in Guillain\u2010Barr\u00e9 syndrome and chronic inflammatory demyelinating polyneuropathy show that some effects of <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> are readily reversible and highly dependent on the serum <jats:styled-content style=\"fixed-case\">IgG<\/jats:styled-content> level. This suggests that in some autoantibody\u2010mediated neuromuscular diseases, <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> directly competes with autoantibodies that reversibly interfere with nerve conduction. Mechanisms of action of <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> which most likely involve direct competition with autoantibodies include: neutralization of autoantibodies by anti\u2010idiotypes, inhibition of complement deposition, and increasing catabolism of pathologic antibodies by saturating <jats:styled-content style=\"fixed-case\">FcRn<\/jats:styled-content>. Indirect immunomodulatory effects are not as likely to involve competition and may not have the same reversibility and dose\u2010dependency. Pharmacodynamic analyses should be informative regarding most relevant mechanism(s) of action of <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> as well as the role of autoantibodies in the immunopathogenesis of each disease. Better understanding of the role of autoantibodies and of the target(s) of <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> could lead to more efficient use of this therapy and better patient outcomes.<\/jats:p>","DOI":"10.1111\/jns5.12048","type":"journal-article","created":{"date-parts":[[2013,11,7]],"date-time":"2013-11-07T02:58:41Z","timestamp":1383793121000},"page":"275-296","source":"Crossref","is-referenced-by-count":52,"title":["Rapid and reversible responses to <scp>IVIG<\/scp> in autoimmune neuromuscular diseases suggest mechanisms of action involving competition with functionally important autoantibodies"],"prefix":"10.1111","volume":"18","author":[{"given":"Melvin","family":"Berger","sequence":"first","affiliation":[{"name":"Departments of Pediatrics and Pathology Case Western Reserve University Cleveland OH USA"},{"name":"Immunology Research and Development CSL Behring, LLC King of Prussia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"McCallus","sequence":"additional","affiliation":[{"name":"Department of Editorial Services Complete Publications Solutions, LLC Horsham PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy Shin\u2010Yi","family":"Lin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, School of Medical Sciences, and Neuroscience Research Australia and Prince of Wales Clinical School University of New South Wales Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,12,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2011.06305.x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1329196"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jnr.20395"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1001\/archinte.1986.00360190143020","article-title":"High\u2010dose intravenous immunoglobulin in the management of myasthenia gravis","volume":"146","author":"Arsura EL","year":"1986","journal-title":"Arch Intern Med"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.44.3_Part_1.429"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.47.3.678"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2010.10.030"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI117520"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/nm836"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-05-1447"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.11346"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0090-1229(85)90027-3"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2013.01.001"},{"key":"e_1_2_12_15_1","unstructured":"BirdSJ(2013). 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