intravenous immunoglobulin (Baygam, Octagam)

Introduction

Pooled human IgG safe for intravenous administration.

Indications

• Guillain-Barre syndrome
• chronic inflammatory demyelinating polyradiculopathy (CIDP)
• myasthenia gravis
• polyneuropathy associated with IgG or IgM paraproteins
• dermatomyositis
• congenital & common variable hypogammaglobulinemia
• severe combined immunodeficiency syndrome
• X-linked hyper IgM syndrome
• Kawasaki syndrome
• idiopathic thrombocytopenic purpura (ITP)
• Wiskott-Aldrich syndrome
• uses for which efficacy is less well establshed
  • IgG subclass deficiency
  • prematurity
  • multiple myeloma
  • postoperative infections
  • chronic lymphocytic leukemia
  • severe asthma

Dosage

• hypogammaglubulinemia:
  • start: 200 mg/kg IV monthly
  • increase to 300, 400 or 600 mg/kg, if clinical response (assessed by number of infections) is inadequate
  • larger doses have greater efficacy in children, but perhaps not in adults
• dermatomyositis
  • 2000 mg/kg every 4 weeks (Octagam 10% solution)
• IM injectable solution (150 mg/mL): Baygam

Adverse effects

• fever/chills
• myalgia (generally controlled by low flow rates)
• headache
• rash
• renal failure (generally reversible)
• dyspnea (generally controlled by low flow rates)
• aseptic meningitis (rare, but more common with migraine)
• anaphylaxis in IgA-deficient patients (rare)
• immunoglobulin-associated hemolytic anemia
• NO risk of transmission of HIV or hepatitis
• preparations containing sucrose, maltose & glycine may cause acute renal failure

Mechanism of action

(postulated mechanisms)

• floods the recipient with diverse array of antibodies, some of which are anti-idiotypic antibodies that may neutralize patient autoantibody production
• may inhibit binding of activated complement to target cells, thus reducing complement-mediated damage to cell membranes
• downregulation of immunoglobulin (including autoantibody) synthesis
• may block Fc receptors on macrophages
• may induce suppressor T-cell activity

More general terms

• pharmacologic combination
• immune globulin
• immunoglobulin-G (IgG, Cuvitru)