The efficacy and safety of intravenous immunoglobulin in pemphigus vulgaris and bullous pemphigoid: a systematic review and meta-analysis.

Autoimmune blistering diseases (AIBDs) encompass various skin conditions that involve the production of autoantibodies that attach to specific antigens found in the skin and mucous membranes. This systematic review examined the efficacy and safety of intravenous immunoglobulin (IVIG) therapy for AIBDs. The search included PubMed, Science Direct, Google Scholar, Wiley, and EBSCO using the following keyword combinations: (Pemphigus Vulgaris OR Bullous Pemphigoid OR Autoimmune Blistering Disease) AND (Intravenous Immunoglobulin OR IVIG) AND (Efficacy OR Long-term Outcomes) AND (Safety OR Adverse Effects OR Quality of Life). Of 617 papers, 12 articles were considered suitable for the systematic review and extracted through the database search. A meta-analysis demonstrated an efficacy of 85.0% (95% confidence interval [CI]: 75.5-92.3, p<0.001) for IVIG therapy in AIBDs. Subgroup analyses showed relapse rates of 18.2% (95% CI: 9.3-27.0, p<0.001) and adverse event rates of 48.0% (95% CI: 28.7-67.3, p<0.001). Rapid clinical responses occurred within 1-4 weeks, with sustained remission lasting up to 44 months. Corticosteroid use was reduced by 76-90%, and autoantibody titers declined significantly. While adverse events were common (26-88% of patients), most were mild, with severe complications (<5%). IVIG is effective for AIBDs, offering rapid control, durable remission, and significant steroid reduction. Standardized protocols for dosing and monitoring are needed, and future research should focus on large-scale trials to confirm long-term benefits.