IVIg combines the power of thousands of immune systems into one drug. This allows IVIg to successfully treat an array of immune disorders. Research continues to find new uses for IVIg and its potential is exciting for many. Read on to learn more about the uses of IVIg as well as what side effects to look out for.

What is IVIg?

Intravenous immune globulin (IVIg) is a mixture of antibodies that is used to treat a variety of immune system disorders. It is made by gathering blood from thousands of donors to create a concentrated collection of antibodies.

Some people may need IVIg because their body does not make enough antibodies on its own. In this case, IVIg provides new antibodies for the immune system to help fight infections.

Another reason why people may use IVIg is if their immune systems have begun attacking their body’s own cells. The components inside IVIg can stop the immune system from thinking that normal, healthy cells are a threat.

IVIg is used in many conditions including genetic disorders, autoimmune diseases, and infections [R].

The mechanism behind how IVIg works is still not fully understood. Nonetheless, the use of IVIg is growing in many countries despite its very high cost [R+].

The World Health Organization has placed IVIg on its List of Essential Medicines. This list details the most effective and safe medications needed for basic healthcare systems.

Components

IVIg is created from the blood of between 1000 to 15000 individual donors. Depending on the manufacturer, different amounts of donors are used [R].

All IVIg products contain mostly IgG antibodies. This mirrors the human immune system where IgG is the most common antibody [R].

Some products may also contain trace amounts of IgA and IgM. These types of antibodies are less desirable than IgG because they are less effective. In addition, some people may experience a severe allergic reaction to IgA [R].

Various cells and proteins that are a part of the immune system can also be present in IVIg [R].

When the use of IVIg became popular, the World Health Organization published standards on how IVIg should be manufactured. These requirements include [R]:

  • Use at least 1000 individual donors
  • Minimize the presence of IgA
  • Do not include harmful preservatives
  • Do not modify IgG molecules

Mechanism of Action

The way IVIg works is complex and not fully understood. The effectiveness of IVIg is most likely due to multiple mechanisms of action.

The simplest way IVIg works is by providing extra antibodies to the immune system. Once it enters the blood, the antibodies inside IVIg will kill bacteria or viruses [R].

IVIg also increases the growth of cells that support the immune system. These cells help in immune system communication and identifying harmful substances [R].

Another way IVIg works is by eliminating defective antibodies. In autoimmune disorders, defective antibodies mistakenly attack normal human cells. IVIg is able to remove and stop the production of these self-attacking antibodies [R].

At high doses, IVIg blocks the complement system. The complement system normally improves the function of antibodies. This can be a problem when defective antibodies attack human cells. IVIg stops the complement system from activating, which prevents inflammation and organ damage [R].

Parts of IVIg can also bind to different white blood cells to control their activity and production. By reducing white blood cell activity, IVIg is effective in many autoimmune disorders [R].

Some research suggests that IVIg may repair the protective layer on nerve cells. Another cell study shows IVIg may prevent skin cells from dying, which is useful in severe skin reactions. Research on how IVIg works is ongoing and it may have more mechanisms of action. [R, R].

Uses of IVIg

1) Impaired Immune System

Genetic Disorders

Some genetic disorders reduce or completely block the body’s ability to create antibodies. People with these disorders are extremely vulnerable to infections [R+].

The most common treatment is IVIg, which replaces the missing antibodies in the immune system. For these genetic disorders, IVIg is usually given every 3-4 weeks for the rest of the individual’s life [R+].

One analysis of 17 different studies looked at 676 people who are unable to create any antibodies. They found that IVIg reduces the risk of infection and the need for hospitalization. They also show that IgG levels in the blood correlated to risk of infection. An increase of 100 mg/dL of IgG decreases the risk of pneumonia by 27% [R].

Some people with this genetic disorder are able to create antibodies, but at a reduced rate. Observational studies of this disorder show that IVIg also reduces the number of pneumonia cases and prevents lung damage [R, R].

Leukemia

Leukemia is a type of bone marrow cancer that affects white blood cells. Some forms of leukemia can reduce antibody production which leads to recurrent infections.

IVIg is added to normal cancer therapy if infections become a concern. According to a review of 9 trials, IVIg reduces the frequency of infections. However, they also found IVIg does not reduce the overall risk of death [R].

A cost analysis determined that IVIg may not be a cost-effective treatment in this cancer. The high cost of the drug and the inconvenience of constant treatments may outweigh the benefits that IVIg provides [R].

HIV in Children

HIV disease is caused by a viral infection that affects multiple cells in the immune system. Progressive decline in the immune system can eventually lead to AIDS. In AIDS, the body is especially vulnerable to infection.

In the past, IVIg was used in children with HIV to prevent infections. Older clinical trials show that IVIg decreases infection time and the frequency of hospitalizations [R, R].

However, these studies were performed before newer HIV treatments were available. This new class of medications, called highly active antiretroviral therapy, have mostly replaced IVIg [R, R+].

2) Autoimmune Diseases

Nerve Disorders

Many autoimmune diseases can affect the nerves. These disorders occur when antibodies attack nerves or the protective layer that surrounds them. This can lead to muscle weakness, decreased reflex response, and a loss of senses.

Treatment of these nerve disorders usually includes IVIg or plasma exchange (PE). PE works by filtering the blood and removing unwanted antibodies [R+].

An example of one of these nerve disorders is Guillain-Barré syndrome. According to a review of 12 clinical trials, IVIg and PE both improve recovery time in this disorder. There was no difference in effectiveness or side effects between the two [R].

Chronic inflammatory demyelinating polyneuropathy is another autoimmune disorder that affects the nerves. An analysis of 5 large reviews found that IVIg improves short-term disability in this disorder [R].

IVIg is preferred in children and for those with poor access to veins. Clinical trials have shown people are less likely to complete therapy with PE due to difficult vein access [R].

Research suggests IVIg may help in other nerve disorders as well. In one analysis, IVIg improved strength in 78% of people and reduced disability in 39%. A different long-term study found that IVIg may also repair nerve cells over time [R, R]

Eye Disorders

IVIg may be helpful in a disorder called Graves ophthalmopathy. In this disorder, antibodies attack different tissues in the eyes which causes inflammation. Symptoms can vary from mild discomfort to severe swelling that requires urgent treatment [R].

The typical treatment for this disorder is steroids. Small studies show that IVIg and steroids are equally effective at improving eye symptoms. IVIg has less frequent and milder side effects compared to steroids [R, R].

Birdshot retinochoroidopathy is a similar condition that involves eye inflammation. One study of 18 patients with this disease found that vision improved in half of the people who took IVIg [R].

Blood Disorders

Idiopathic thrombocytopenic purpura is an autoimmune disorder that causes red or purple spots on the skin. These spots can occur when antibodies mistakenly attack platelets in the blood. The destruction of platelets will reduce the blood’s ability to clot. This leads to internal bleeding that appears as spots on the skin.

Mild cases of this disorder usually don’t require treatment. Children can often recover on their own without medical help [R].

IVIg is used when there is a high risk of bleeding complications. It works by slowing the destruction of platelets by the immune system [R+].

Clinical trials show that IVIg is more effective than steroids, a common treatment for this condition. IVIg increases platelet counts and reduces bleeding in children and adults. IVIg also has fewer side effects compared to steroids [R, R, R].

A different disorder, Henoch-Schonlein purpura, also leads to bright red spotting. The spotting in this disorder is caused by antibodies that clump together in the blood vessels. These antibody clumps cause inflammation and bleeding [R].

Case reports reveal that IVIg may be helpful in these bleeding complications. One case report of severe stomach bleeding found that IVIg quickly resolves symptoms. According to a different case report, IVIg may help with bleeding complications in the brain [R, R].

Muscle Disorders

A rare muscle disorder called dermatomyositis causes serious inflammation in the muscles. Symptoms can include skin rash, worsening muscle weakness, weight loss, and fever. The exact cause of this inflammation is unclear, but it is likely an immune response to an infection.

This condition is normally treated with steroids and immune-suppressing medications [R].

A few studies have explored the use of IVIg. According to one trial, IVIg improved muscle symptoms in only 3 of the 11 people studied [R].

Another report found that IVIg improved symptoms in all 9 children who were studied. Researchers followed the children for 4 years and found that 6 of them were able to decrease their steroid dose while taking IVIg [R].

Arthritis

Some forms of arthritis commonly affect children. Arthritis is an inflammation of the joints that can cause tiredness, flu-like symptoms, and pain. Antibodies attacking tissues in the joints cause this inflammation.

Normal treatment includes NSAIDs, steroids, or drugs that modify the immune system [R+].

One study examined the potential of IVIg in 27 children with arthritis. Researchers found IVIg improves fever symptoms and reduces the need for steroids. However, there was no effect on the overall progression of the disease [R].

In a clinical trial of 25 children, IVIg improved the symptoms of about 75% of participants. Once IVIg was stopped the benefits quickly wore off [R].

Pregnancy Complications

Antiphospholipid syndrome (APS) is an autoimmune disorder where antibodies attack a form of fat found in cells. This results in an increased risk of forming blood clots.

This disorder is a special concern in pregnant women. APS increases the risk of pregnancy complications such as miscarriage, early delivery, and stillbirth [R].

According to one small study, IVIg reduces the number of infant development problems and the need for intensive care [R].

However, a research review examining 13 studies found that IVIg increases the risk of pregnancy loss or premature birth [R].

Other Autoimmune Diseases

Research suggests IVIg may also be effective in [R+]:

3) Infection-Related Diseases

Kawasaki Disease

Kawasaki disease mainly affects children and causes inflammation of the blood vessels. Symptoms include fever, rash, and redness of mouth and tongue. This disease is believed to be triggered by an infection.

Doctors typically use IVIg therapy with aspirin during the first 10 days of the disease. This practice helps prevent blood vessels in the heart from weakening [R+].

An analysis of 16 clinical trials shows that IVIg reduces injury to the heart and decreases the duration of fever. They also found that a single high dose of IVIg was the most effective strategy [R].

Infection Caused by Organ Transplant

People that receive organ transplants must take medications that suppress their immune system. This must be done to ensure their body does not reject the new organ. However, these medications also put them at an increased risk for infections.

Certain viruses can cause severe lung inflammation in bone marrow transplant patients [R].

Studies show that high dose IVIg, combined with antiviral drugs, increases the chance of survival. One study of 25 people found that 52% of patients survived after taking IVIg + antiviral drugs. When patients only took antiviral drugs only 15% survived [R].

Another small study found that 7 of 10 patients on IVIg + antiviral drugs survived and had no recurrence of the disease after 10 months. In contrast, all of the patients that took only one of the medications did not survive [R].

Infection of the Gut

Certain viruses can cause severe diarrhea in children. The virus infects the lining of the small intestine which causes inflammation.

Treatment primarily consists of making sure the patient is well hydrated [R].

One clinical trial has explored the use of IVIg in this infection. Children who received IVIg had a quicker recovery and reduced hospital stay. This is one of the few instances where IVIg is taken by mouth [R].

Toxic Shock Syndrome

Toxic shock syndrome is a life-threatening disease caused by toxins. Some types of bacteria are able to produce toxins which trigger a massive response by the immune system. This causes fever and low blood pressure which eventually can lead to organ failure.

An observational study found that 67% of people treated with IVIg survived after 30 days. In the group that did not receive IVIg only 34% survived. Researchers suggest that IVIg may be an effective add on medication [R].

Other Infection-Related Diseases

IVIg is also potentially effective in [R+]

  • Cystic fibrosis [R]
  • Post-surgery infection [R]
  • Lower respiratory tract infection [R]
  • Colon inflammation [R, R]

4) Miscellaneous Uses of IVIg

Asthma

Asthma is caused by chronic inflammation in the airways of the lungs. Symptoms include shortness of breath, coughing, wheezing, and chest tightness.

Several studies have looked at IVIg’s potential in asthma. According to clinical trials, IVIg is no more effective than placebo in many cases. IVIg also does not reduce the frequency of infections [R, R].

However, IVIg may be beneficial in people with immune system abnormalities and asthma. According to case reports, IVIg reduces the number of infections and reduces the severity of symptoms [R+, R, R].

Severe Skin Reactions

Toxic epidermal necrolysis and Stevens-Johnson syndrome are two forms of severe skin reactions. These reactions are most commonly caused by certain medications. The symptoms are intense blistering and peeling of the skin which requires hospitalization.

Based on an analysis of 17 observational studies, IVIg slightly reduces the risk of death, especially in children [R].

A different analysis that looked at 26 studies found that IVIg + steroids reduce recovery time by about 3 days. This benefit was greatest in Asians. However, IVIg did not reduce the risk of death [R].

Transplant Rejection

A transplanted organ can sometimes be rejected by the recipient’s body. Transplant recipients must take immune-suppressing medications to decrease the risk of rejection.

There are many ways a transplant can be rejected. One process involves an immediate rejection caused by an antibody attack.

IVIg, combined with other medications, may be effective for this type of rejection. One study found therapy that includes IVIg results in a 91.7% survival rate for kidney transplants after 3 years [R, R].

Infection-Related Mental Disorders

In rare cases, bacterial infections can cause mental disorders in children. This leads to a variety of behavioral and psychological symptoms, which occur shortly after an infection.

This disorder was discovered fairly recently and is not well understood. It may be caused by the immune system attacking brain cells [R].

There is hope that IVIg may be beneficial as a treatment. A case series of 12 children found that a single dose of IVIg provided lasting symptom improvement [R].

However, a recent clinical trial of 35 children found that IVIg did not perform significantly better than placebo [R].

Overall, research is lacking for this rare disorder and experts are not sure if IVIg should play a role [R, R].

Hives

Delayed pressure urticaria is a rare form of hives. It causes painful swelling in locations where the skin has experienced sustained pressure. The symptoms are often severe and significantly decrease the quality of life [R].

Steroids are often the only treatment that is effective. However long-term use of steroids comes with many drawbacks [R].

Case reports indicate that IVIg might be beneficial in this form of hives. IVIg improved the symptoms in 5 out of 8 patients who did not respond to other medications [R].

Side Effects

IVIg is generally well tolerated and safe. Approximately 20-40% of people experience a mild side effect at some point. The side effects depend on the disease being treated and how IVIg is given [R+].

Injection Site Side Effects

As the name implies, IVIg is primarily given through IV. Side effects can sometimes occur due to needle insertion.

Sometimes a short needle is used to inject IVIg right under the skin. This type of needle causes more injection site side effects, but reduces the number of infusion side effects [R+].

Injection site side effects include [R+]:

  • Pain
  • Bleeding
  • Bruising
  • Swelling
  • Redness

Infusion Side Effects

Infusion reactions are the most common side effects of IVIg. These side effects occur while IVIg is slowly delivered to the person. Infusion of IVIg typically takes 2 to 4 hours.

Infusion side effects can be prevented or reduced by slowing or stopping the delivery of IVIg. Steroids and Tylenol are also effective at reducing reactions [R+].

Infusion reactions include [R+]:

  • Nausea
  • Mild fever
  • Feeling sick
  • Dizziness
  • Chest tightness
  • Fatigue
  • Chills
  • Vomiting

Side effects are more likely to occur with [R+]:

  • The very first infusion
  • A fast infusion
  • A large dose
  • A long break between infusions
  • Switching to a different brand
  • Recent bacterial infection

Serious Side Effects

There are cases of IVIg causing moderate to severe side effects in some users. These side effects are usually delayed, occurring days to weeks after infusion [R+].

Severe side effects include [R+]:

  • Allergic reaction
  • Persistent headaches
  • Kidney damage
  • Blood clots
  • Blood cell abnormalities
  • Lung injury

Contamination

Contamination is always a concern for any product created from blood donors. IVIg product quality is monitored and tested, but there are rare cases of infection caused by contamination.

In the early 90s, IVIg was linked to several hepatitis C infections. Since then newer decontamination techniques have been developed and there have been no new cases of infection [R, R].

IVIg is also linked to cases of parvovirus B19 infection. This virus is not destroyed by the decontamination process. Normally this is not a concern because the antibodies in IVIg should neutralize the virus. Despite this, there have been 2 cases of individuals developing this infection from IVIg [R, R].

Limitations and Caveats

Research Limitations

IVIg is a potential treatment in a wide variety of disorders. However, many of these diseases are extremely rare, which makes clinical research difficult. Many of the potential uses of IVIg are based on a few case reports [R+].

The dose of IVIg can vary depending on the disease being treated. Research is still trying to determine the optimal dosage for each disease. Efforts are also being made to find the lowest effective dose of IVIg in different conditions to save on cost [R, R+].

Researchers also do not fully understand how IVIg therapy works. A better understanding of IVIg could improve treatment and recommendations.

Cost

The high cost of IVIg is a significant issue. The yearly cost of IVIg and infusion services can range from about $50,000 to $100,000. For some conditions, individuals must receive IVIg every 3-4 weeks for the rest of their life. This can end up costing millions of dollars [R].

Cost analysis shows that IVIg is not cost effective in many diseases. Often other therapies can improve quality of life at a lower cost [R, R].

Different Brands

There are currently over a dozen IVIg products available. Manufacturers use varying amounts of donors for their IVIg. This can lead to different concentrations of components. The inactive ingredients, pH level, and decontamination methods can also differ between each product [R+].

Switching from one IVIg product to another may require slight adjustments to the dosage. Using a new brand can also potentially cause new or different side effects [R+].

Drug Interactions

Kidney Toxicity

Rare cases of kidney failure have been reported with IVIg use. Research shows that kidney injury is more common with brands of IVIg that contain sugar as a preservative. IVIg should be used cautiously when taking other drugs that are toxic to the kidneys [R].

Live Vaccinations

The interaction between IVIg and vaccines has not been studied. However, the antibodies in IVIg can theoretically decrease the effectiveness of live vaccines. The CDC recommends waiting 8 months after taking IVIg before receiving MMR or varicella vaccinations [R].

NSAIDs

One study of 182 children looked at the drug interaction between IVIg and NSAIDs. They found that NSAIDs may have a negative effect on IVIg when treating Kawasaki disease [R].

Dosage

IVIg dosage is personalized for each person and disease. The dose, infusion rate, dosage schedule, and duration of treatment can all vary depending on the condition. Researchers are still trying to find the optimal dose for each disease.

The dose of IVIg is based on the weight of the person. Different brands of IVIg may require slightly different doses [R+].

IVIg comes in a liquid form that is given through IV or injected underneath the skin [R+].

FDA approved IVIg doses [R]:

  • Primary humoral immunodeficiency — 200-800 mg/kg every 3-4 weeks
  • Immune thrombocytopenic purpura — 1 g/kg for 2 consecutive days
  • Chronic inflammatory demyelinating polyneuropathy — 2 g/kg over 2-5 days, then 1 g/kg every 3 weeks

Studies suggest that IVIg dosage should be based on maintaining a certain IgG level in the blood. Researchers have found that IgG levels above 700 mg/dL reduce the risk of pneumonia [R, R].

People with genetic disorders may require IVIg for the rest of their life.

Some infection-related diseases require a single IVIg dose of up to 2 g/kg [R, R].

In special cases, IVIg can be taken by mouth to fight gut infections. A dose of 300 mg/kg was used in studies [R].

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