Literature for and against immune treatments….

23 01 2013

From Dr. Braverman’s blog:

Posted on: 12-Oct-2010 5:21am
Pts have called me and asked “why do other doctors quote literature that says immune treatments don’t work or are dangerous?”

The first thing everyone has to realize is that there is literature on both sides of the argument, in fact, most of the literature today supports the diagnosis and management of immune related causes of RPL (most of this is from journals around the world as not much research is done on this topic in the US). Most of the doctors who quote the literature against Immune-related rejection and treatment do not have any background in immunology and don’t have the ability to see the flaws in these studies. Most studies against the use of IVIG or even PLI [Paternal Leucocyte Immunization] were and are flawed by many factors. The most significant is the complete lack of understanding of the many cells lines involved in immune tolerance and hence immune rejection and simply treating anyone with RPL without knowing the reasons you are treating won’t give you any answers as to whether therapy works. Most of the recent literature is starting to address this issue and is looking at a complete immune cell analysis and drawing much better conclusions. Certainly there is no argument the immune system is involved in pregnancy loss, and that treatments help many patients avoid miscarriage and IVF failure (just look at our list of patients that have had so many losses, some as many as 18, before we treated them and you’ll understand that the treatments work.) Our job is to try and shorten the list of those that need to be treated so patients who don’t need the treatment don’t get it. But as a last option for so many patients you just can’t ignore the prescence of these treatments.

The second issue is that of PLI and the fact that it is not FDA approved due to a Lancet study in 1998. [I’m looking for the cite of the study.]  Again the world literature is already way beyond this conclusion and has showed the studies here were flawed by improper preparation of the PLI injections and loss through refrigeration of the very important receptors on the cells that were to be injected to help develop immune tolerance. But again the lack of understanding of immunology by those quoting these studies has guided many away from treatments that are now helping so many patients around the world.
Lastly is the safety of the treatments. There is abundant literature showing the safety of IVIG and large series have shown this treatment to be safe not only in pregnancy but in all other autoimmune syndromes that it has been used to treat. This is consistent with our history of no serious complications in all the years we have been treating patients.
The most important issue seems to be experience in seeing, diagnosing and treating this very complex group of patients. We rely on the great success we have had over the years as the best proof that our diagnosis and treatments are effective. It’s unfortunate that many have begun treating patients for immune related pregnancy loss with limited knowledge of the field and as we have stated on this site , these are best left in the hands of those with great experience as this still is the most important quality necessary for success.
I will gladly share the literature on these topics and any one should feel free to call me to discuss them. Our success is no coincidence, and misguided literature should not sway someone from at least exploring and understanding these issues and if they relate to their own problems with RPL. It would have been a shame if all the people we have treated over the years avoided looking into these issues.”
 
To contact Dr. Braverman, fill out the form on the right hand side of his page here.

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