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Immunoglobulins

IVIg (Intravenous Infusion of Immunoglobulins)

IVIg is a solution of IgG antibodies normally present in adult human blood.1 The IgG antibodies are extracted from the combined plasma of more than 1,000 screened donors and treated to eliminate bacterial and viral contaminants. It is used to treat immune deficiency and many other conditions on-label and off-label.1

IVIg temporarily increases the platelet count in about 80% of ITP patients.2  The duration of the response varies and the treatment can be repeated when the platelet count drops.

IVIg is manufactured by different companies and each brand has slightly different features and side effect profiles. See the BDI Pharma IVIg Comparision Chart and the Immune Deficiency Foundation Chart for more information. The newest brands approve for the treatment of ITP are Gammaplex (BPL) and Octagam 10% (Octapharma).

Dosage

IVIg is given intravenously for a period of several hours. There are two different dosage options: .4 g/kg per day for 5 days, or infusions of 1 g/kg per day for 1 to 2 days. The higher-dose, shorter-term administration leads to a more rapid rise in platelet count, but higher toxicities 3

Side Effects

The most common side effects of IVIg include headache, fever, chills, nausea or vomiting, muscle pain or chest pain. Slowing down the infusion or premedication can help eliminate these problems or decrease their severity. Fortunately, most patients with these side effects can be helped by slowing down the rate of infusion. Premedication with acetaminophen, antihistamines, or occasionally steroids can also help decrease side effects.4

Rare and more serious side effects include: blood clots8, hemolytic anemia, pulmonary edema, and aseptic meningitis syndrome.5

Patients who are IgA deficient have a greater chance of developing anaphylactic shock.1  IVIg can cause renal dysfunction and renal failure, expecially with preparations that are very concentratred or have a high sugar content.5

Predicting Success

IVIg does not work very well for those people with ITP who have anti-GPIbalpha antibodies on their platelets.6,7

References

1. Wikipedia: intravenous immunoglobulin http://en.wikipedia.org/wiki/Intravenous_immunoglobulin
2.
Godeau B et al. “Intravenous immunoglobulin or high-dose methylprednisolone, with or without oral prednisone, for adults with untreated severe autoimmune thrombocytopenic purpura: a randomised, multicentre trial.” Lancet. 2002 Jan 5;359(9300):23-9. http://www.ncbi.nlm.nih.gov/pubmed/11809183
3.
Benesch M et al. “Low-dose versus high-dose immunoglobulin for primary treatment of acute immune thrombocytopenic purpura in children: results of a prospective, randomized single-center trial.” J Pediatr Hematol Oncol. 2003 Oct;25(10):797-800. http://www.ncbi.nlm.nih.gov/pubmed/14528103
4. Immunedisease.com (Baxter) http://www.immunedisease.com/patients-and-families/ivig-therapy/ivig-side-effects.html
5. American Society of Health-System Pharmacists: IVIg side by side comparison http://www.ashp.org/s_ashp/docs/files/DShort_IVIGsidebysideupdatedDec07.pdf

6. Webster ML et al. “Relative efficacy of intravenous immunoglobulin G in ameliorating thrombocytopenia induced by antiplatelet GPIIbIIIa versus GPIbalpha antibodies.” Blood. 2006 Aug 1;108(3):943-6. http://www.ncbi.nlm.nih.gov/pubmed/16861348
7. Go RS et al. “The association between platelet autoantibody specificity and response to intravenous immunoglobulin G in the treatment of patients with immune thrombocytopenia.” Haematologica. 2007 Feb;92(2):283-4. http://www.ncbi.nlm.nih.gov/pubmed/17296593
8. “FDA Safety Communication: New boxed warning for thrombosis related to human immune globulin products.” June 10, 2013 http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ucm355986.htm