What is evidence of efficacy for the use of intravenous immunoglobulin (IVIG)?

Updated: Jul 05, 2018
  • Author: Jessica Katz, MD, PhD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

See the list below:

  • The effectiveness of IVIG as a treatment for recurrent spontaneous pregnancy loss remains unproven. IVIG does not prevent further losses among women with primary, recurrent, spontaneous pregnancy loss.

  • IVIG is a useful treatment for immunodeficiencies with a greater role than simple replacement therapy. [38]

  • One study suggests that IVIGs are effective in the treatment of pretibial myxedema and may have immunomodulatory action in patients with Graves disease and related disorders.

  • Patients with ataxic sensory neuronopathy with Sjögren syndrome and stiff man syndrome have benefited from IVIG therapy.

  • Selected patients with chronic lymphocytic leukemia who are at risk of bacterial infection can be substantially protected from this complication by regular therapy with IVIG.

  • Chronic idiopathic pericarditis is a chronic disease of unknown origin characterized by recurrent episodes of pericardial inflammation. The cause of the recurrence is unknown, although in some cases it may be traced to a viral infection and to the presence of antimyocardial antibodies. Because a viral infection can induce an autoimmune process through a mechanism of molecular mimicry and because the optimal therapy to prevent recurrences has not been established, Peterlana et al reasoned that treatment with human IVIG could be beneficial for patients who did not respond to previous immunosuppressive therapies. Four patients affected by chronic idiopathic pericarditis benefited from 5 treatments of monthly high-dose human IVIG (0.4 g/kg/d for 5 d) followed by administration every 2 months. Three of 4 patients could permanently discontinue steroid therapy and were still in remission after years of follow-up. [39]

  • The beneficial effects on cardiac function from IVIG treatment in patients with dilated cardiomyopathy is not due to neutralization of antireceptor autoantibody. [40]

  • IVIG and interferon have been reported as a successful treatment for optic neuritis in patients with pediatric multiple sclerosis.

  • Successful management of cataplexy with IVIGs at narcolepsy onset has been reported. [41]

  • IVIG therapy reportedly has been successful in the treatment of acute disseminated encephalomyelitis.

  • IVIG therapy for Alzheimer disease has had mixed success.

  • Patients with Churg-Strauss syndrome have achieved complete clinical and functional recovery with a long-term stable remission with IVIG therapy and plasmapheresis, and the incidence of adverse effects was low. [42]

  • IVIG treatment for the first year from onset of the first neurological event suggestive of demyelinative disease significantly lowers the incidence of a second attack and reduces disease activity as measured by brain magnetic resonance imaging. [43]

  • IVIG was well tolerated and therapy was completed in 9 patients with livedoid vasculitis who were treated with IVIG. In all patients, the clinical evaluation revealed a marked improvement of erythema, pain, and healing of areas of active ulceration. Although this was an open noncontrolled study, the authors propose that IVIG is a promising therapeutic option for livedoid vasculitis refractory to other treatment modalities. [44]

  • High-dose immunoglobulins combined with extracorporeal photochemotherapy were reported in the treatment of one case of febrile ulceronecrotic Mucha-Habermann disease. [26]

  • Although case reports and case series have described dramatic responses to IVIG in people with presumed viral myocarditis, a Cochrane Review concluded that until higher-quality studies have demonstrated benefit in a particular group of patients, IVIG for presumed viral myocarditis should not be provided as routine practice in any situation. [45]


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