Intravenous Immunoglobulin (IVIG) for Multiple Sclerosis

IVIG has some specific applications in MS, but there is conflicting evidence.

Intravenous immunoglobulin (IVIG) is made out of antibodies that have been filtered out of donated human blood pooled from many donors and suspended in solution. Immunoglobulins are types of antibodies that are secreted by white blood cells and plasma cells.

IVIG seems to work in neurological diseases by increasing the action of some parts of the immune system and decreasing the action of others. No one exactly knows all of the mechanisms of action in multiple sclerosis (how it works), but scientists are honing in on which components of the immune system are effected by IVIG and the role they play in multiple sclerosis.

What Is it For?

IVIG is used in MS to slow progression of the disease, reduce number of and limit disability and MS symptoms.

IVIG is used "off-label" in MS, meaning it has not been approved for this use by the FDA (many drugs are used off-label in MS, as discussed in this article: What is "off-label" use of drugs and is it legal?).

Specific Uses in MS

As a general disease-modifying therapy for relapsing-remitting MS, it just seems like the evidence isn't there to jump at the chance to take IVIG. However, it does show promise in a couple of specific areas:

Post-Partum Women: IVIG has been shown to be effective in preventing relapses in the period following childbirth, which occurs in about one-third of women.

Cannot Tolerate DMTs: It is recommended that IVIG be used as a second-line therapy in people with RRMS who cannot tolerate the current disease-modifying therapies, namely Copaxone, Betaseron, Avonex and Rebif.

Pregnant Women: Some data and reports suggest that giving a patient IVIG throughout pregnancy may help reduce the chance of relapse during pregnancy, although the risk of relapse during pregnancy is greatly reduced anyway.

Clinically Isolated Syndrome: One small study showed that people given IVIG during a clinically isolated syndrome were only about half as likely to convert to clinically definite MS within a year.

Secondary-Progressive MS: There has been at least one European study that showed that IVIG does help slow disease progression in people with primary progressive MS, measured by EDSS scores. However, other endpoints did not show any effect. No significant improvement or effect was demonstrated in people with secondary progressive MS in this study.

NOT During a Relapse: IVIG has not been shown to have any benefit when administered during a relapse when the person is already getting treated with Solu-Medrol.

How Effective Is It?

At this time, no one really knows the answer to this question for multiple sclerosis. IVIG has been proven effective in the treatment of other neurological diseases, such as Guillain-Barré syndrome and myasthenia gravis.

There have been several studies that have shown that IVIG has positive effects on MS, while others demonstrate no effect whatever in MS. Most of the trials have been small and not rigorous enough to "prove" anything one way or another in terms of effectiveness.

One Australian study did show a small, but statistically significant improvement in disability, as measured by the expanded disability status scale (EDSS). Others have shown small effects on improving MRI (reducing size or number of lesions). However, many others have shown no difference whatsoever between IVIG and placebo as a disease-modifying approach for relapsing-remitting MS. Several positive studies have shown that IVIG administered right after childbirth does have a statistically significant effect on reducing relapses in new mothers.

Usual Dosage/How Taken

Dosages and frequency of doses have not been established for MS, but some recommend that 1 gram of IVIG per kilogram of body weight be given monthly. Some doctors also give a course of 400 mg/kg/day for 5 days.

Side Effects of IVIG

The most common side effect of IVIG is headache, which is usually responsive to over-the-counter painkillers, such as Tylenol. Other side effects include: fever, joint pain, chest pain and vomiting. Some people get a rash after receiving IVIG.

Some serious, but rare side effects of IVIG have been noted. These include: aseptic meningitis (inflammation of the layers of tissue surrounding the brain with no infectious cause), thrombotic events (heart attacks, strokes, pulmonary embolism, deep vein thrombosis) and kidney dysfunction or failure.

Potential Interactions and Warnings

IVIG should NOT be used in people with the following conditions:

  • IgA deficiency
  • Kidney problems/failure
IVIG should be used WITH CAUTION in people with the following conditions:
  • Heart problems
  • Diabetes
  • Sensitivity to immune globulins
  • Sensitivity to maltose or sucrose (these ingredients may be in some IVIG preparations)

The only clearly defined potential drug interaction with IVIG is with live virus vaccines, as the antibodies can render the vaccines ineffective.


IVIG has become extremely expensive, at an estimated $100 per gram. At a typical dosage of 1g/kg body weight, a 154-pound (70 kg) person would therefore need 70 grams of IVIG, costing $7000 for each monthly infusion for the drug alone (without associated facility or nursing costs).

Additional Information/Points

Risk of Infection Transmission? Yes, IVIG is made from components of human blood. While many tests are done to make sure that the donors are free of known infections, there is a tiny theoretical risk that the blood could contain an infectious agent, like a virus.

My Bottom Line

Given the evidence for IVIG, I really DO wish it had been administered to me right after I gave birth, as it may have prevented a pretty extreme relapse that occurred.

However, I don't think I would turn to IVIG unless I exhausted my options with the current disease-modifying therapies. It just doesn't seem convincing enough at this point to justify the expense, in my case.

I would consider IVIG if I couldn't tolerate any of the available drugs or if I had primary progressive MS and my doc thought it was worth a try.

I have heard one person say that they would try IVIG before many other things because it is "natural," as it is derived from human plasma. In my opinion, this is a faulty way of thinking. IVIG is a drug, plain and simple, with potential side effects and massive costs. Most drugs have some sort of "natural" component, such as the velvet from elk antlers (an Alzheimer's syndrome drug), the saliva from Komodo dragons (medication for diabetes) or the urine of pregnant mares (hormone replacement therapy). All drugs are to be respected and carefully considered before starting them, regardless of the origin of their components.


Cohen JA. How effective is intravenous immunoglobulin for the treatment of relapsing-remitting multiple sclerosis? Nat Clin Pract Neurol. 2008 Nov;4(11):588-9. Epub 2008 Oct 14.

Dudesek A, Zettl UK. Intravenous immunoglobulins as therapeutic option in the treatment of multiple sclerosis. J Neurol. 2006 Sep;253 Suppl 5:V50-8.

Elovaara I, Apostolski S, van Doorn P, et al. EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases: EFNS task force on the use of intravenous immunoglobulin in treatment of neurological diseases. Eur J Neurol. 2008 Sep;15(9):893-908.

Elovaara I, Hietaharju A. Can we face the challenge of expanding use of intravenous immunoglobulin in neurology? Acta Neurol Scand. 2010 Jan 19. [Epub ahead of print]

Pöhlau D, Przuntek H, Sailer M, et al. Intravenous immunoglobulin in primary and secondary chronic progressive multiple sclerosis: a randomized placebo controlled multicentre study. Mult Scler. 2007 Nov;13(9):1107-17. Epub 2007 Jul 10.

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