Treating MS With Intravenous Immunoglobulin (IVIG)

Weighing the Evidence in Support of Therapy

Intravenous immunoglobulin (IVIG) is a type of therapy in which a mixture of antibodies (immunoglobulins) are injected into a vein with the aim of improving a person's immune function. Antibodies are defensive proteins produced by the body in response to a disease.

IVIG is believed to work in neurological diseases by stimulating certain parts of the immune system and suppressing others. No one knows for certain how it works, and, as such, IVIG is prescribed off-label (without specific FDA approval) for diseases in which person's immune system is severely compromised.

These may include neonatal sepsis, pediatric HIV, and certain cases of advanced HIV. It is also used as second-line treatment for treatment in relapsing-remitting multiple sclerosis (RRMS).

Uses of IVIG in Multiple Sclerosis

IVIG is used in multiple sclerosis (MS) to slow progression of the disease and to limit the disability caused by the disease. While there is no clear consensus as to when IVIG is most appropriate, it has shown promise in a number of specific areas:

Some studies have also suggested that IVIG given at the time of the first neurological symptom of MS (called the clinically isolated syndrome, or CIS) may reduce a person's chance of converting to a definitive diagnosis of MS.

Much of that research has also been met with uncertainty or skepticism.

Effectiveness of IVIG

At this time, no one really knows how effective IVIG is in treating or slowing the progression of MS. Most of the evidence has been based on its effects on other neurological diseases, such as Guillain-Barré syndrome and myasthenia gravis.

Studies focused purely on IVIG and MS have been mixed at best.

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 a slight improvement in the size or number of brain lesions on an MRI.

Others, meanwhile, have shown no difference in the effectiveness of IVIG compared to placeboes in treating RRMS.

Perhaps the one area of promise is the use IVIG right after childbirth, the practice of which has shown to significantly reduce the rate of relapses in new mothers.

Dosage and Administration

While the dosage and frequency of doses have not been established for RRMS, many prescribers recommend a dosage of one gram per kilogram of body weight given monthly. Others will prescribe a course of 400 mg/kg per day over five days.

Side Effects

The most common side effect of IVIG is headache (which can usually be treated with an over-the-counter painkiller like Tylenol). Other possible side effects include fever, joint pain, chest pain, and vomiting. Less commonly, a drug-related rash may develop.

Some serious but rare side effects have also been noted, including aseptic meningitis, heart attack, stroke, deep vein thrombosis, kidney dysfunction, and kidney failure.

Interactions and Contraindications

IVIG should not be used in people with kidney problems or IgA deficiency (a genetic disorder characterized by the lack of an antibody that protects against infections in the mouth, airways, and digestive tract). A

Meanwhile, IVIG should be used with caution in persons with:

  • Heart problems
  • Diabetes
  • Sensitivity to immunoglobulins
  • Sensitivity to maltose or sucrose (ingredients used in some IVIG formulations)

The only clearly defined interaction with IVIG involves live vaccines. Immunoglobulins can render a vaccine ineffective and void any protection the vaccine may afford.

Cost of Treatment

IVIG has become extremely expensive at an estimated $100 per gram. For a person weighing 154 pounds (70 kilograms), the recommended monthly dosage would end up costing around $7,000 per infusion, not including the facility administration and nursing costs.

Some insurance companies may cover the cost, but it is often difficult to motivate for treatment and usually requires an appeals process to finally gain approval. If approved, insurance co-pays can be extremely high. However, some IVIG manufacturers do offer patient assistance programs (PAPs) to either defray or entirely cover the cost of treatment.

A Word From Verywell

If IVIG is recommended, you may need to advocate for yourself in order to gain approval from your insurance. With that being said, it's important to understand the benefits and limitations of the proposed treatment—essentially what the research tells us and doesn't tell us.

If you are not absolutely clear about this, do not hesitate to seek a second opinion from a qualified specialist.

Sources:

Bayry, J.; Hartung, H.; and Kaveri, S. "IVIg for relapsing–remitting multiple sclerosis: promises and uncertainties." Trends Pharm Sci. 2015; 36(7):419-421.

Gilardin, L.; Bayry, R.; and Kaveri, S. "Intravenous immunoglobulin as clinical immune-modulating therapy." CMAJ. 2015; 187(4):257-264.

Continue Reading