CIDP Treatment with IVIG
IVIg is a blood product often used to treat CIDP and GBS type neuropathies among other human diseases. It is made up of immunoglobulins (say: im-YOU-no-GLOB-you-lins), which are also called antibodies. Antibodies help protect the body from germs, such as viruses. Antibodies are made by the immune system. The immune system is the part of the body that helps fight infection.
Neuropathy can be treated and sometimes cured with IVIG treatment.
IVIg has been introduced as the main therapy for CIDP and GBS over the last two decades. Multiple well-controlled studies have demonstrated that approximately 50–70% of patients respond to IVIg
Maintenance therapy with IVIg can induce sustained remission, increase quality of life and prevent further axonal loss and permanent nerve damage.
IVIg has an FDA indication for treatment of CIDP.
Improvement occurs within a few weeks, and rarely recovery may be dramatic, appearing 1 or 2 days after completing the infusion. Usually the benefit is transient (1–6 weeks) with 50% of patients relapsing within weeks to months and subsequently requiring regular infusions to maintain maximum improvement. 76% of IVIg-treated patients had improved strength.
The recently published IVIg in CIDP Efficacy (ICE) trial was the largest and longest randomized, double-blind placebo-controlled trial demonstrating sustained efficacy of IVIg in CIDP utilizing a loading dose of 2 g/kg administered over 2–5 days, followed by repeated infusions of 1 g/kg administered every 3 weeks for 6 months.
Because it has a low frequency of adverse effects and is easy to administer, most experts believe IVIg has been established as the standard of care and should be the initial treatment of choice for patients with CIDP. Joint Task Force of the EFNS and the PNS . J Peripher Nerv Syst. 2010 Mar; 15(1):1-9.
IVIg is contraindicated in patients with absolute IgA deficiency or a history of a previous allergic reaction following exposure to human immune globulin. Minor side effects are common and include headache, malaise, fatigue, and fever. Other rare adverse effects include: aseptic meningitis, rigors, myalgias, flushing, fluid overload with edema or congestive heart failure, renal insufficiency (presumably due to hyperosmolarity), hemolysis, transient neutropenia, back, chest, leg or abdominal pain, and eczematous rash. Rarely, IVIg induces a hyperviscosity syndrome with increased risk for deep venous thrombosis, myocardial ischemia, or stroke.