Intravenous immunoglobulin use in neurology

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Intravenous immunoglobulin (IVIg), derived from pooled plasma of healthy donors, has significantly advanced autoimmune neurologic disorder treatment over 30 years.
• Randomized controlled trials support IVIg's efficacy in Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), multifocal motor neuropathy (MMN), and dermatomyositis.
• IVIg also shows effectiveness in myasthenia gravis exacerbations, stiff-person syndrome, and autoimmune encephalitides.

Purpose of the Study:

• To review the clinical applications of IVIg in various neurologic diseases.
• To discuss the therapeutic value of subcutaneous immunoglobulin (SCIg) as an alternative or adjunct to IVIg.
• To address practical considerations for IVIg therapy, including dosing, administration schedules, and treatment cessation.

Main Methods:

• Review of randomized controlled trials and clinical studies evaluating IVIg and SCIg in neurologic disorders.
• Analysis of treatment outcomes for specific autoimmune neuropathies and encephalitides.
• Discussion of current challenges, including IVIg supply shortages and the exploration of recombinant alternatives.

Main Results:

• IVIg is an approved and effective treatment for several autoimmune neurologic conditions.
• Both IVIg and SCIg demonstrate efficacy as maintenance therapy, particularly in CIDP and MMN.
• Growing demand for IVIg necessitates exploring alternative strategies, including recombinant products.

Conclusions:

• IVIg remains a cornerstone therapy for numerous autoimmune neurologic disorders.
• SCIg offers a viable alternative for maintenance therapy in specific conditions.
• Addressing IVIg supply limitations and investigating novel therapeutic approaches are critical for future patient care.