IVIG Issues
Carol L. Koski, M.D., Principal Author
Although no controlled studies have been conducted, IVIG given in multiple courses, appears to provide continuous efficacy in children (Simmons, 1997) and IVIG is effective in treating childhood CIDP (Nevo, 1996; Kornberg, 2004).
IVIG Co-morbid Disease Issues
Reports indicate that from 12% to 18% of patients with confirmed diabetes meet the electrophysiologic criteria for CIDP. In addition, the risk for CIDP is 11 times greater in patients with type 2 diabetes than in patients without diabetes. (Sharma, 2002)
Based on anecdotal reports, 20% to 80% of patients with demyelinating polyneuropathy and diabetes respond to IVIG therapy. The differences in the response rates relate to how the disease is defined.
IVIG Safety Issues
After more than a decade of experience, the safety of IVIG has been established. For any potential recipient, the risk of adverse reactions must be weighed against the likelihood of significant benefit. In general, the adverse reactions to IVIG therapy are usually minor and occur in no more than 10% of patients. (Dalakas, 2004)
A Warning Box exists for IVIG products stating that these products have been reported to be associated with renal dysfunction, acute renal failure, osmotic nephrosis and death.
Many of these reactions reflect the infusion rate and include:
- headache
- myalgias
- fever
- chills
- tachycardia
- hypertension
- hypotension
These reactions can usually be limited by slowing the infusion rate or by pre-medication with aspirin, acetaminophen, methylprednisolone, or diphenhydramine. (Koski, 2005)
In addition, post-infusion fatigue, fever, or nausea may occur and continue for up to 24 hours after the session.
A slow rate of infusion is advisable for patients with a compromised cardiovascular system or CHF (congestive heart failure) to avoid a rapid systemic fluid overload. (Dalakas, 2004)
Patients who are immobile, have increased serum viscosity, and those with pre-existing vascular disease can be at increased risk for rare thromboembolic events. Pre-existing renal insufficiency or the use of IVIG products containing sucrose can increase the risk of renal failure, particularly in patients with diabetes. Patients with a history of migraine are at risk for developing aseptic meningitis following IVIG therapy. (Dalakas, 1999; Dalakas, 2004)
Rarely, IVIG may be associated with the development of a hemolytic anemia. (Wilson, 1997) Thrombotic events have been reported in association with IVIG. There have also been reports of noncardiogenic pulmonary edema and very rare reports of aseptic meningitis.
IVIG therapy should be used with extreme caution in patients with a history of allergy or renal disease. (Koski, 2002)
