From the Guidelines
Intravenous immunoglobulin (IVIG) is the treatment of choice for Acute Inflammatory Demyelinating Polyneuropathy (AIDP), with a recommended dosage of 0.4 g/kg body weight daily for 5 days, due to its equal efficacy to plasma exchange but greater ease of administration and availability. The use of IVIG in AIDP is supported by the most recent and highest quality study, which found that IVIG and plasma exchange are equally effective treatments for Guillain-Barré Syndrome, with comparable risks of adverse events 1.
Key Points to Consider
- IVIG is preferred over plasma exchange due to its ease of administration and wider availability, making it a more practical option for treatment 1.
- The recommended dosage of IVIG is 0.4 g/kg body weight daily for 5 days, which has been shown to be effective in treating AIDP 1.
- Other treatments, such as corticosteroids, have not been proven effective in treating AIDP, and may even have a negative effect on outcome 1.
- Antimicrobial or antiviral treatment may be considered in patients with AIDP who have an ongoing infection, but is not a primary treatment for the condition 1.
Administration and Monitoring
- Treatment with IVIG should be initiated as soon as possible after diagnosis, ideally within the first two weeks of symptom onset, to maximize efficacy.
- Patients should be monitored for potential adverse effects, including headache, fever, nausea, and rarely, thromboembolic events or aseptic meningitis.
- IVIG is particularly beneficial for non-ambulatory patients and those with rapidly progressive weakness, bulbar involvement, or respiratory compromise.
From the Research
IVIg Use in AIDP
- IVIg is a commonly used treatment for Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), a condition similar to Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) but with a longer duration of symptoms 2, 3, 4.
- According to a systematic review, IVIg is one of the first-line treatments for CIDP, along with corticosteroids and plasma exchange 3.
- High-quality evidence suggests that IVIg produces more short-term improvement in disability than placebo, but serious adverse events are probably no more common than with placebo 5.
- The European Academy of Neurology/Peripheral Nerve Society guideline recommends IVIg or corticosteroids as initial treatment in typical CIDP and CIDP variants, and considers IVIg as first-line treatment in motor CIDP 6.
- IVIg may be less effective in patients with IgG4 autoantibodies to paranodal proteins, who have characteristic clinical features and poorer response to IVIg 4.
Comparison with Other Treatments
- IVIg has been compared to other treatments, including corticosteroids, plasma exchange, and immunosuppressants, with varying results 2, 3, 5.
- A systematic review found that IVIg produces more short-term improvement in disability than placebo, but there is no clear difference in short-term improvement in impairment when compared with intravenous methylprednisolone or oral prednisolone 5.
- The choice of treatment may depend on individual patient factors, such as response to previous treatments and presence of adverse events 4, 6.
Adverse Events and Safety
- IVIg can cause adverse events, including thromboembolic events, haemodynamic changes, and difficult venous access 2, 5.
- Serious adverse events related to IVIg are probably no more common than with placebo, but can occur in some patients 5.
- The risk of adverse events should be carefully considered when deciding on treatment, and patients should be closely monitored for any signs of adverse events 4, 6.