intravenous immunoglobulin (Baygam, Octagam)
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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
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)[3]
- 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[1]
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
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2018.
- ↑ Intravenous Immunoglobulin: Prevention and Treatment of Disease http://consensus.nih.gov/cons/080/080_statement.htm
- ↑ 3.0 3.1 Ingram I FDA Approves IVIG for Dermatomyositis. Octagam 10% lands indication for adults following results of ProDERM trial. MedPage Today July 20, 2021 https://www.medpagetoday.com/rheumatology/generalrheumatology/93660
- ↑ NEJM Knowledge+ Allergy/Immunology