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Intravenous immunoglobulin: striving for appropriate use
Arvind Kumar1, Suzanne S Teuber, M Eric Gershwin
1Division of Rheumatology, Allergy and Clinical Immunology, Department of Internal Medicine,University of California at Davis School of Medicine, Davis, Calif. 95616, USA.
International Archives of Allergy and Immunology
|May 10, 2006
Summary
Intravenous immunoglobulin (IVIG) shows efficacy in many off-label uses beyond immune deficiency, but evidence quality varies. Appropriate IVIG use requires strong clinical data and biological rationale due to cost and risks.
Area of Science:
- Immunology
- Pharmacology
Background:
- Intravenous immunoglobulin (IVIG) is a primary treatment for immune deficiencies.
- IVIG is also widely used for neuroimmunologic, infectious, dermatologic, hematologic, autoimmune, inflammatory, and idiopathic disorders.
- Objective data supporting off-label IVIG use are often limited.
Purpose of the Study:
- To review the evidence for off-label uses of IVIG.
- To assess the quality of data supporting these indications.
- To inform appropriate clinical decision-making regarding IVIG use.
Main Methods:
- A PubMed literature review of over 400 publications.
- Keywords used: 'intravenous immunoglobulin'.
- Publications focused on immune deficiency were excluded.
Main Results:
- Significant evidence supports IVIG efficacy in several off-label indications, establishing it as standard care for some syndromes.
- Data for some conditions are not well-controlled or randomized, relying on limited case reports.
- IVIG is expensive, carries risks, and its use requires careful consideration of clinical data and biological rationale.
Conclusions:
- Appropriate IVIG use is challenging due to cost, potential supply limitations, and donor plasma constraints.
- Establishing voluntary registries for IVIG use in disorders with lacking evidence is crucial.
- Registries would facilitate the initiation of randomized, controlled clinical trials to generate robust evidence.