IVIG (Intravenous Immunoglobulin)
Description
Intravenous immunoglobulin (IVIG) is a product that is not manufactured, but rather purified from the plasma of healthy human blood donors. It is typically given by slow delivery from a needle inserted into a blood vein. Each IVIG preparation is made from the pooled plasma of 3,000-10,000 blood donors, which is then purified to contain more than 90% antibodies (the natural proteins that your body normally makes to help you to fight infections and to serve other functions for the immune system). IVIG preparations are carefully screened during purification to detect and eliminate viral infections that could be transmitted through intravenous infusion (eg, hepatitis C virus). However, it is impossible to completely eliminate all possible viral infections from IVIG preparations.
Fast facts
- IVIG is made from the pooled plasma of healthy blood donors
- IVIG is given intravenously (i.e. through the vein) and sometimes by needle under the skin (subcutaneously).
- IVIG dampens the immune system, resulting in benefits for certain autoimmune diseases.
- Because IVIG is made from donor blood, there is a very small risk of getting infections from IVIG
Uses
IVIG is FDA-approved for the treatment of various immune deficiency states. In addition, it is used to treat Kawasaki disease, immune thrombocytopenic purpura (ITP), pemphigus vulgaris and certain autoimmune neurologic conditions. IVIG is also effective in treating dermatomyositis and certain types of vasculitis.
How it works
The exact mechanism by which IVIG benefits autoimmune disease is unknown. It is likely that there are multiple mechanisms of IVIG action that may be specific for each disease.
Dosing
IVIG has traditionally been given monthly through a vein. Infusions for autoimmune diseases, such as dermatomyositis, typically involve high doses of IVIG that take 2-5 consecutive days for administration of the full monthly dose. These infusions are typically given at a hospital or infusion center, although home IV delivery can also be used and are repeated every 4 to 6 weeks. In order to avoid IVs and minimize side effects, IVIG is now being delivered via an alternative subcutaneous method. Although this subcutaneous delivery of IVIG has been established safe and effective for immunodeficiencies, the data pertaining to its efficacy for other diseases (including autoimmune disease) is lacking at present.
Time to effect
Improvements in skin and muscle disease can be seen within weeks to months after the first infusion.
Side effects
Because it is derived from donor blood, IVIG historically has carried with it the potential risk of transmitting infections. Since the 1980s, dedicated virus inactivation steps have been added to the purification process. Since the introduction of these techniques, there have not been any documented cases of IVIG-transmitted infections. Donor populations are also screened for the presence of HIV and hepatitis B and C, and in some cases, other viruses.
The most common side effects are directly related to the infusion, and occur in 25-35% of patients. These are usually mild and include headache, chills, fever, muscle pain, chest discomfort, fatigue and/or nausea. Slowing the rate of infusion and giving acetaminophen (Tylenol) and antihistamines before the infusion decrease the risk of these side effects. These side effects typically self-resolve. More severe side effects can be minimized or prevented by giving an intravenous infusion of corticosteroids prior to the IVIG infusion. For severe headaches, sometimes a medication called cyproheptadine (Periactin) can help as a pre- and post-medication. A particularly severe form of headache, called aseptic meningitis, can also occur. This is typically characterized by a very severe headache, fever, stiff neck and/or aversion to light (photophobia). Luckily, this condition typically self-resolves over 1-2 weeks.
Other more severe side effects of IVIG include the risk of possible blood clots (potentially resulting in clots in the veins and/or lungs, heart attack or stroke). If you have a history of this problem this should be carefully discussed with your doctor, as it has been shown that you are at higher risk of this complication with IVIG. Also, anybody with risk factors for clots (i.e. pregnancy, smoking, oral contraceptive use) should carefully consider the risks and benefits of IVIG and discuss this with their doctor.
There are other serious, but rare side effects of IVIG. IVIG can rarely result in kidney injury. Rare but serious skin reactions can occur with IVIG. In addition, patients are at risk of anaphylaxis, especially those with a deficiency of a type of immunoglobulin called IgA. Your doctor should check you for this deficiency before giving you IVIG. There are IVIG products that have been depleted of IgA.
Points to remember
IVIG is pooled plasma from healthy blood donors
IVIG is usually given at a hospital or clinic-based infusion center
IVIG is infused for 3 to 5 hours per day, for 2 to 5 days in a row, every 4 to 6 weeks
Prior to receiving IVIG make sure that your doctor has checked your IgA level
Headache is the most common side effect of IVIG infusion
Before being treated with IVIG, make certain your physician knows that you could be at increased risk for blood clots based on other medical issues (i.e. pregnancy, smoking, oral contraceptive use)
Drug interactions
Be sure to tell your doctor about all of the medications you are taking, including over-the-counter drugs and natural remedies. IVIG may bind to other medications given by vein or subcutaneously, inactivating them.
Information to discuss with your primary care physician and other specialists
Be sure to tell your other physicians that you are taking this drug. Women taking this medication should discuss appropriate forms of birth control with their primary care physician or gynecologist. IVIG may decrease the protection provided by vaccines, if the vaccines are given during IVIG treatment.
For more information
The Rheumatologic Dermatology Society (RDS) has compiled this list to give you a starting point for additional information. The RDS does not endorse or maintain these Web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your dermatologist for more information and before making any decisions about your care.
Myositis Association of America