From the Guidelines
Intravenous immunoglobulin (IVIG) should be administered at a dose of 0.4 g/kg daily for 5 days, as this regimen has been shown to be effective in the treatment of Guillain-Barré syndrome 1, 2. The administration of IVIG should be done in a controlled clinical setting under the supervision of healthcare professionals experienced with its use.
- The dose of IVIG may vary depending on the indication, with 0.4-2 g/kg being the typical range for adults.
- For autoimmune conditions such as Guillain-Barré syndrome, a dose of 0.4 g/kg daily for 5 days is recommended 1, 2.
- Administration should begin at a slow rate, with patients monitored for adverse reactions including headache, fever, chills, and hypotension.
- Premedication with acetaminophen, diphenhydramine, and sometimes corticosteroids can help prevent reactions.
- Adequate hydration before and during infusion is important, and sucrose-free IVIG formulations are preferred for patients with renal impairment, diabetes, or thrombotic risk factors 3, 4. The mechanism of action of IVIG involves providing passive immunity through antibodies, modulating immune responses, and neutralizing autoantibodies.
- IVIG has been shown to be effective in reducing the prevalence of coronary artery abnormalities in Kawasaki disease, with a dose of 2 g/kg as a single infusion being recommended 4.
- However, for Guillain-Barré syndrome, the recommended dose is 0.4 g/kg daily for 5 days, as this has been shown to be equally effective as plasma exchange in treating the condition 2.
From the Research
Ivig Administration
- Ivig administration is used for various conditions, including immune thrombocytopenic purpura (ITP), primary humoral immunodeficiencies (PHI), and chronic neuropathy 5, 6.
- The recommended dosage of IVIG in ITP is 400 mg/kg/day for two to five days, while for the treatment of PHI, the usual dosage is 100-400 mg/kg every three or four weeks 5.
- IVIG has also been used for antimicrobial prophylaxis in bone marrow transplant and burn patients, and in patients with malignancies, HIV infection, cystic fibrosis, neonatal sepsis, and respiratory syncytial virus infection 5.
- Adverse reactions to IVIG are often mild and related to the infusion rate, but can include more severe reactions such as anaphylactoid reactions and aseptic meningitis 5, 7.
Indications and Usage
- IVIG is most commonly used in the treatment of chronic neuropathy, including chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy 6.
- Other common indications for IVIG include the treatment of hypogammaglobulinemia, ITP, renal transplant rejection, myasthenia gravis, Guillain-Barre syndrome, necrotizing fasciitis, autoimmune hemolytic anemia, and Kawasaki disease 6.
- IVIG has also been used in the treatment of multifocal motor neuropathy, with some studies showing short-term efficacy, but further studies are needed to prove long-term efficacy 8, 9.
Safety and Efficacy
- Low-dose IVIG regimens have been shown to be effective and safe in children with ITP, with a lower incidence of adverse events in patients younger than 5 years of age 7.
- IVIG-induced neutropenia is a rare adverse event, with most reports being mild and transient, but some cases of chronic severe neutropenia have been reported 8.