Neurologist Susan W. Lee, DO, answers common questions about this treatment option for myasthenia gravis.
Intravenous immunoglobulin (IVIG) is a pooled collection of antibodies derived from donors’ plasma. It’s used to treat people with immunodeficiencies to protect them against infection and to treat those with autoimmune or inflammatory conditions.
In myasthenia gravis (MG), IVIG can be used in a few different ways:
- To treat acute exacerbations: IVIG is often used to treat acute exacerbations because improvements are typically seen in less than 1 week of treatment.
- To act as a maintenance therapy: IVIG can also be used as maintenance therapy, especially as an alternative treatment when other immunotherapies don’t work.
- To bridge the gap between therapies: Because of its rapid action, IVIG may be given as a “bridge” when someone with MG is starting on slower onset immunotherapies.
- To prepare for surgery: IVIG may also be given before surgery for MG.
IVIG has both anti-inflammatory and immunomodulating effects to restore immune function. It activates various immune cells in order to provide protection against a wide array of diseases.
The main benefits of IVIG in MG are its rapid effects and efficacy, even in people who haven’t responded to other forms of MG treatment.
Infusion reactions may occur but are typically mild. These may consist of:
- flushing
- headache
- fever
- chills
- fatigue
- fluid retention
More rare but serious adverse side effects include:
- kidney impairment
- aseptic meningitis
- anaphylaxis
- thrombotic events (stroke, heart attack, or blood clots)
IVIG is given as an intravenous (IV) infusion, typically at an infusion center or hospital, though it can sometimes be given at home via a home health agency.
The dosage given is based on your weight, and the total dose is typically spread over 2 to 5 days. Each infusion takes several hours.
Your doctor may give you oral or IV medications prior to IVIG infusion in order to minimize the risk of adverse reactions.
Most people experience a response within 1 to 2 days to less than a week after IVIG administration.
The exact frequency and duration of IVIG treatment depends on your specific condition.
For example, if IVIG is being given for an acute exacerbation, you may only need it infrequently during an exacerbation.
Or, if it’s being used as maintenance therapy, you may receive it every few weeks to every few months.
Your doctor will help determine the best treatment plan for you.
Talk with your doctor or the infusion site about options to help ease your fear of needles. There may be factors in the environment that can be changed to help you feel more comfortable.
For example, you may be able to play relaxing music during the infusion or even make arrangements for at-home administration.
Your doctor may also consider prescribing a low dose sedative for you to take prior to the infusion.
Finally, subcutaneous immunoglobulin (SCIG), an immunoglobulin treatment administered under the skin, is an alternative treatment you could consider. SCIG can be administered at home and uses a smaller needle.
There are several alternatives to IVIG.
One treatment with a similar rapid onset to IVIG is plasma exchange. This is a process by which your blood is removed through a venous catheter and filtered through a machine to remove harmful antibodies. It’s then returned to you with donor plasma.
There are also newer immunotherapies approved by the Food and Drug Administration (FDA) for treating MG, such as:
- eculizumab (Soliris)
- efgartigimod (Vyvgart)
- ravulizumab (Ultomiris)
More refractory MG may require off-label treatment with rituximab (Rituxan, Riabni) or chemotherapy agents such as cyclophosphamide (Cytoxan).
Your doctor can discuss your options with you and help determine the next steps.
Dr. Susan W. Lee is an ABMS board certified neurologist with fellowship training in clinical neurophysiology. She currently practices in Los Angeles, California, and her subspecialty interests include the management of epilepsy and headache disorders.