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intravenous immunoglobulin (Baygam, Octagam)
Pooled human IgG safe for intravenous administration.
Indications:
1) Guillain-Barre syndrome
2) chronic inflammatory demyelinating polyradiculopathy (CIDP)
3) myasthenia gravis
4) polyneuropathy associated with IgG or IgM paraproteins
5) dermatomyositis
6) congenital & common variable hypogammaglobulinemia
7) severe combined immunodeficiency syndrome
8) X-linked hyper IgM syndrome
9) Kawasaki syndrome
10) idiopathic thrombocytopenic purpura (ITP)
11) Wiskott-Aldrich syndrome
12) uses for which efficacy is less well establshed
a) IgG subclass deficiency
b) prematurity
c) multiple myeloma
d) postoperative infections
e) chronic lymphocytic leukemia
f) severe asthma
Dosage:
- hypogammaglubulinemia:
a) start: 200 mg/kg IV monthly
b) increase to 300, 400 or 600 mg/kg, if clinical response (assessed by number of infections) is inadequate
c) larger doses have greater efficacy in children, but perhaps not in adults
- dermatomyositis
- 2000 mg/kg every 4 weeks (Octagam 10% solution) [3]
- IM injectable solution (150 mg/mL): Baygam
Adverse effects:
1) fever/chills
2) myalgia (generally controlled by low flow rates)
3) headache
4) rash
5) renal failure (generally reversible)
6) dyspnea (generally controlled by low flow rates)
7) aseptic meningitis (rare, but more common with migraine)
8) anaphylaxis in IgA-deficient patients (rare)
9) immunoglobulin-associated hemolytic anemia
10) NO risk of transmission of HIV or hepatitis
11) preparations containing sucrose, maltose & glycine may cause acute renal failure [1]
Mechanism of action: (postulated mechanisms)
1) floods the recipient with diverse array of antibodies, some of which are anti-idiotypic antibodies that may neutralize patient autoantibody production
2) may inhibit binding of activated complement to target cells, thus reducing complement-mediated damage to cell membranes
3) downregulation of immunoglobulin (including autoantibody) synthesis
4) may block Fc receptors on macrophages
5) may induce suppressor T-cell activity
General
pharmacologic combination
immune globulin (Gamastan, Gamimune N, Gammagard, Gammar, Sandoglobulin, Venoglobulin-I, Venoglobulin-S, ISG, Vivaglobulin, Gamunex, Privigen, Gammaplex, Flebogamma, Gammaked, Bivigam, Carimune, Hizentra)
immunoglobulin-G (IgG, Cuvitru)
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 18.
American College of Physicians, Philadelphia 1998, 2006, 2009, 2018.
- Intravenous Immunoglobulin: Prevention and Treatment of Disease
http://consensus.nih.gov/cons/080/080_statement.htm
- Ingram I
FDA Approves IVIG for Dermatomyositis.
Octagam 10% lands indication for adults following results of ProDERM trial.
MedPage Today July 20, 2021
https://www.medpagetoday.com/rheumatology/generalrheumatology/93660
- NEJM Knowledge+ Allergy/Immunology