This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
To the Editor:
We read with interest the Prevention of Relapse with Intravenous Immunoglobulin (PRIVIG) dose-finding trial in relapsing-remitting multiple sclerosis (RRMS) by Fazekas et al.1 The authors concluded that the trial “seriously questions the utility of IVIg for the treatment of relapsing-remitting MS” and that the “negative results of the PRIVIG trial therefore cannot be attributed to a problem of data quality.” However, the results of the PRIVIG trial should be carefully interpreted because of several methodologic limitations.
The rationale for choosing the two doses of IV immunoglobulin (IVIg) at 0.2 and 0.4 gm/kg is unclear, considering that higher doses of IVIg (2.0 gm/kg) have been used in previous studies. The authors did not present any immunologic rationale for choosing the two doses. It may have been interesting to examine higher doses, including the possibility of a third arm at doses >1.0 gm/kg.
It is also unclear why the primary endpoint of “proportion of relapse-free patients after only 48 weeks” was chosen. This endpoint has never been used as a primary outcome in any of the pivotal trials. Furthermore, the expectation of demonstrating an increase of 50% relapse-free patients in the active arm compared to placebo arm that was expected to have 50% relapse-free patients is also overly optimistic. This magnitude of effect in the proportion of relapse-free patients has not been demonstrated in several pivotal …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Hemiplegic Migraine Associated With PRRT2 Variations A Clinical and Genetic Study
Dr. Robert Shapiro and Dr. Amynah Pradhan