Intravenous immunoglobulin treatment in children with PANS/PANDAS conditions
Health technology assessment|
The Norwegian Institute of Public Health has investigated the effect and safety of treatment with immunoglobulins in the conditions Pediatric Acute onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS).
PANS (Pediatric Acute onset Neuropsychiatric Syndrome)/PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections) is described as an abrupt, dramatic onset of obsessive-compulsive disorder (OCD) or severely restricted food intake, combined with other neuropsychiatric symptoms and in the absence of a verified neurological or medical disease. Patients receive psychological and pharmacological treatments. The latter includes anti-inflammatory, antibacterial or immunomodulating treatments, such as intravenous immunoglobulin.
The evidence base for this rapid review is a Swedish health technology assessment of various treatment alternatives in children with PANS/PANDAS symptoms. Two small randomized controlled trials have studied the effect of intravenous immunoglobulin in these patients.
Our findings are the following:
- No conlusion can be drawn on whether intravenous immunoglobulin has any effect on health-related quality of life as no study has reported data on this outcome.
- It is uncertain whether intravenous immunoglobulin improves level of functioning or symptoms (very low certainty of evidence, GRADE ⊕◯◯◯).
- Side-effects and adverse events can occur in line with the summary of product characteristics (low certainty of evidence GRADE ⊕⊕◯◯).
Costs related to immunoglobulin treatment will vary considerably depending on dose and weight. As none of the human immunoglobulin preparations on the market have approved indication with specified dosage for the treatment of PANS/PANDAS, it is difficult to estimate what the costs will be if immunoglobulin treatment is introduced into the Norwegian clinical practice.