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Drug Insight: the use of intravenous immunoglobulin in neurology—therapeutic considerations and practical issues

Nature Clinical Practice Neurology volume 3, pages 36–44 (2007)Cite this article

Abstract

Over the past few years, we have achieved increasing success in the treatment of a number of autoimmune-mediated disorders affecting nerves and muscles. This success is partly attributable to the use of high-dose polyclonal intravenous immunoglobulin (IVIg), which has dramatically changed our treatment options. On the basis of results from controlled, but non-FDA-approved, clinical trials, IVIg is now the treatment of choice for Guillain–Barré syndrome, chronic idiopathic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy; IVIg offers rescue therapy for patients with rapidly worsening myasthenia gravis, and is a second-line therapy for dermatomyositis, stiff-person syndrome, and pregnancy-associated or postpartum multiple sclerosis attacks. The ability of IVIg to treat such immunologically diverse disorders effectively, coupled with its excellent safety profile, has led clinicians to use the drug more liberally, even in diseases for which the data are weak and not evidence-based and in patients with coexisting conditions. Use of IVIg for such indications can increase the risk of complications while raising the cost of the drug. Practical issues regarding dosing and frequency of infusions generate dilemmas in clinical practice. In this article, we review the current indications for IVIg treatment, address practical issues related to the use and costs of the drug, and summarize its mechanisms of action.

Key Points

  • Intravenous immunoglobulin (IVIg), a natural blood product, has an important role in the treatment of numerous neuroimmunological disorders

  • Currently, it is assumed that multiple therapeutic effects of IVIg act in concert

  • IVIg is the treatment of choice for Guillain–Barré syndrome, chronic idiopathic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy

  • IVIg offers rescue therapy in myasthenia gravis, and second-line therapy for dermatomyositis and stiff-person syndrome

  • Possible novel indications for IVIg include postpolio syndrome, narcolepsy and Alzheimer's disease

  • Increased use of IVIg might have a negative impact on availability and costs

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Authors and Affiliations

  1. R Gold chairs the Department of Neurology at St Josef Hospital, and M Stangel is a consultant in the Department of Neurology, University of Bochum, Medical School of Hannover and a member of the Center for Systems Neuroscience, Hannover, Germany.,

    Ralf Gold & Martin Stangel

  2. MC Dalakas is Chief of the Neuromuscular Diseases Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD and Professor of Clinical Neurology at George Washington University, Washington DC, USA.,

    Marinos C Dalakas

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  1. Ralf Gold
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Correspondence to Ralf Gold.

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Gold, R., Stangel, M. & Dalakas, M. Drug Insight: the use of intravenous immunoglobulin in neurology—therapeutic considerations and practical issues. Nat Rev Neurol 3, 36–44 (2007). https://doi.org/10.1038/ncpneuro0376

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