Information and Resources
Resource, Tools, and information for our patients and team
What is IVIg
Intravenous immunoglobulin (IVIG) is a pooled antibody, and a biological agent used to manage various immunodeficiency states and a plethora of other conditions, including autoimmune, infectious, and inflammatory states. The ultimate goal of this therapy is to normalize a compromised immune system. This activity reviews the indications, mechanism of action, contraindications, adverse effects, and monitoring of IVIG in the treatment of several immune deregulated states. It also highlights the key information pertinent to the healthcare teams managing patients with conditions affecting the immune system and other immune-related conditions
Patient Education: Common Side Effects of IVIG
Side Effects
Common Side Effects of Are:
Fever
Nausea
Headache
Increased heart rate (reported with >5% incidence)
Dangerous Adverse Reactions Include:
Hemolytic anemia
Aseptic meningitis
Thromboembolic events
Immediate anaphylactic reactions
Call 911!
notify your healthcare provider if you have symptoms of allergic reactions such as:
hives; difficulty breathing; wheezing; neck stiffness; swelling in lips, tongue, throat; and dizziness.
Other Side Effects Include:
Chills
Cough
Diarrhea
Flushing
Vomiting
Back pain
Muscle cramps
Abdominal pain
Chest pain/discomfort
Pain and swelling at the injection site
What is SCIg
Administration of immunoglobulin subcutaneously (SCIG) is equally effective in preventing infections and has a lower incidence of serious adverse effects compared to IVIG. The tolerability and acceptability of SCIG has been demonstrated in numerous studies showing improvements in quality of life and a preference for subcutaneous immunoglobulin therapy in patients with antibody deficiencies.
Cost of IVIG treatment
Intravenous immunoglobulin (IVIG) therapy has brought about significant improvements in the lives of numerous individuals dealing with autoimmune and immunodeficiency conditions. However, this treatment can be relatively expensive. For instance, a single IVIG infusion can cost anywhere from $100 to over $350 or more per gram.
On average, the reported cost for IVIG treatment in the US is approximately $9,720, and if patients undergo 4 to 5 infusions per month, then it would cost them around $41,796 per month. Even though IVIG infusions offer hope and an improved quality of life, the financial aspect can be daunting for many patients and their families.
Therefore, if your healthcare provider prescribes IVIG therapy to you or your loved ones, it is important to be aware of the cost associated with IVIG infusion
Patient education: Intravenous immune globulin (IVIG) (Beyond the Basics)
Intravenous immunoglobulin (IVIG) is a pooled antibody, and a biological agent used to manage various immunodeficiency states and a plethora of other conditions, including autoimmune, infectious, and inflammatory states. The ultimate goal of this therapy is to normalize a compromised immune system. This activity reviews the indications, mechanism of action, contraindications, adverse effects, and monitoring of IVIG in the treatment of several immune deregulated states.
Long-term Effectiveness of IVIg Maintenance Therapy in 36 Patients With GAD Antibody–Positive Stiff-Person Syndrome
Despite some study limitations, mainly the lack of a control group due to obvious difficulties in giving placebo for long periods in a rare disease and the constraints of a retrospective chart review, this study has conclusively demonstrated the effectiveness of IVIg as chronic maintenance therapy while highlighting the need for new or novel therapies for the chronic management of SPS.
Privigen Medication
Privigen is a 10 percent liquid human IgG derived from human plasma. It is available in a single, ready-to-use, sterile 10% vial. It is stable at room temperature for the period of its expected lifespan (up to 36 months). This medication has a distribution of IgG subclasses similar to normal serum.
Octogam Fact Sheet
Octagam infusion is an intravenous immune globulin (IVIG) that contains high levels of antibodies derived from the plasma of healthy people. It is a sterile liquid preparation used to boost the body’s natural immune system so it can fight infections and protect the body against diseases.
Infliximab
Infliximab is a biologic, monoclonal-antibody drug. The United States Food and Drug Administration (FDA) has approved infliximab for moderate to severely active Crohn disease in adults and children (six years and above), ulcerative colitis, active rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and chronic severe plaque psoriasis in adult patients. This activity describes the mode of action of infliximab, including adverse event profiles and other key factors, e.g., dosing, pharmacodynamics, pharmacokinetics, and monitoring, and highlights the interprofessional team's role in managing these patients.
TNFi Biologics
TNFi biologics work by targeting something called tumor necrosis factor proteins, or TNFa. TNF is a protein that sends signals to your body, eventually leading to inflammation that causes swelling, pain, and stiffness. By inhibiting, or stopping, TNF, these medications can reduce inflammation. That’s why they’re often called TNF inhibitors (or TNFi). Some of these drugs have been on the market for over ten years.
Some common TNFi biologics are:
Adalimumab (Humira®)
Certolizumab pegol (Cimzia®)
Etanercept (Enbrel®)
Golimumab (Simponi®, Simponi Aria®)
Infliximab (Remicade®)
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)
"A child may be diagnosed with PANDAS when:
Obsessive-compulsive disorder (OCD), tic disorder, or both suddenly appear following a streptococcal (strep) infection, such as strep throat or scarlet fever.
The symptoms of OCD or tic symptoms suddenly become worse following a strep infection.
The symptoms are usually dramatic, happen “overnight and out of the blue,” and can include motor or vocal tics or both and obsessions, compulsions, or both. In addition to these symptoms, children may become moody or irritable, experience anxiety attacks, or show concerns about separating from parents or loved ones."
(https://www.nimh.nih.gov/health/publications/pandas)
IVIg for PANS or PANDAS
"IVIG can be an effective treatment option for children who don’t benefit from antibiotics, behavioral therapy (talk therapy), steroids, and NSAIDs (nonsteroidal anti-inflammatory drugs).
In many cases, a single course of IVIG may reduce symptoms and even reverse PANDAS [3].
Several studies suggest that IVIG for PANS/PANDAS can dramatically improve symptoms.
For example, in a 2021 study, researchers administered IVIG (Octagam 5%) infusions every 3 weeks for a total of 6 infusions over a period of 18 weeks to 21 participants between 4 and 16 years [4].
At the end of the study, they found that all the participants experienced over 50% improvement in their symptoms for at least 8 weeks following treatment and a subset of those patients experienced improvement up to 46 weeks following treatment.
Swedish researchers observed similar results in a 2022 trial. In this trial, 10 children (median age 10 years) received IVIG 2 g/kg monthly for 3 months. 9 children had at least 30% improvement in their symptoms [5].
Most members of the PANS Research Consortium (PRC) prefer IVIG to oral or intravenous steroids for moderate-to-severe PANS [6].
In conclusion, research for the use of IVIG for PANS/PANDAS is ongoing. Available evidence shows promising results, and IVIG is worth a try."
(https://ameripharmaspecialty.com/ivig/considering-ivig-for-pans-pandas-heres-5-things-you-should-know/)