Therapy with intravenous immunoglobulins: complications and side-effects

Therapy with intravenous immunoglobulins (IVIG) is thought to be a safe treatment for a number of immune-mediated neurological diseases. Published data about prevalence of adverse effects range from 11 to 81%. The purpose of our study was to present a representative view on adverse effects by analysis of a large cohort of patients treated by IVIG. In a prospective study, we analysed 117 patients (age 17-79 years) who were treated with IVIG for various neurological diseases including chronic inflammatory demyelinating polyneuropathy, diabetic amyotrophy, inclusion body myositis, multiple sclerosis, Guillain-Barré syndrome, Miller-Fisher syndrome, multifocal motor neuropathy, myasthenia gravis and polymyositis. IVIG therapy was applied at a dose of 0.4 g/kg body weight/day in a total of 408 therapy courses. 42.7% showed adverse events. The majority of patients presented with minor adverse effects, mostly asymptomatic laboratory changes. Rash or mild headache occurred in 8 patients, especially when IVIG was given with infusion flow higher than 10 g/h. Two patients showed a severe complication with deep vein thrombosis. In summary, beside its effectiveness in immune mediated neurological diseases, therapy with IVIG seems to be a safe therapy. Most patients show no or minor adverse effects. Patients with pre-existent disorders like heart or renal insufficiency or immobilised patients, however, may be at higher risk for complications.