Treating MS With Intravenous Immunoglobulin (IVIG)

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Intravenous immunoglobulin (IVIG) is a type of therapy in which a mixture of antibodies (immunoglobulins)—defensive proteins produced by your body in response to a disease—is injected into a vein over the course of several days with the aim of improving your immune function. IVIG is believed to help treat multiple sclerosis (MS) and other neurological diseases by stimulating certain parts of the immune system and suppressing others.

However, no one knows for certain how it works. As such, IVIG is prescribed off-label—without specific approval by the U.S. Food and Drug Administration (FDA)—for diseases in which your immune system is severely compromised. These conditions may include neonatal sepsis, pediatric HIV, and certain cases of advanced HIV. IVIG is also used as a second-line treatment for relapsing-remitting multiple sclerosis (RRMS).

Uses

IVIG is used in MS to slow progression of the disease and to limit the disability it causes. While there's no clear consensus as to when IVIG treatment for MS is most appropriate, it has shown promise in a number of specific areas, including:

Some studies have also suggested that IVIG given at the time of your first neurological symptom of MS, called the clinically isolated syndrome (CIS), may reduce your chance of converting to a definitive diagnosis of MS. Much of that research has also been met with uncertainty or skepticism.

Effectiveness

At this time, no one really knows how effective IVIG is in treating or slowing the progression of MS. Most of the evidence has been based on its effects on other neurological diseases, such as Guillain-Barré syndrome and myasthenia gravis. Studies focused purely on IVIG and MS have been mixed at best.

One Austrian study did show a small but statistically significant improvement in disability as measured by the expanded disability status scale (EDSS). Others have shown a slight improvement in the size or number of brain lesions on a magnetic resonance imaging (MRI) scan.

Other studies, meanwhile, have shown no difference in the effectiveness of IVIG compared to placebos in treating RRMS.

Perhaps the one area of promise is the use of IVIG right after childbirth, which has been shown to significantly reduce the rate of relapses in new mothers.

Dosage

While the dosage and frequency of doses have not been established for RRMS, many prescribers recommend a dosage of 1 gram per kilogram of body weight given monthly. Others will prescribe a course of 400 milligram/kilogram per day over five days.

Side Effects

The most common side effect of IVIG is a headache, which can usually be treated with an over-the-counter painkiller like Tylenol (acetaminophen) or Advil/Motrin (ibuprofen).

Other possible side effects include:

  • Fever
  • Joint pain
  • Chest pain
  • Vomiting
  • Nausea
  • Fatigue
  • Dizziness
  • Chills
  • Rash (less common)

Rare Side Effects

Some rare but serious side effects have also been noted, including:

Interactions and Contraindications

IVIG should not be used in people with kidney problems or IgA deficiency, a genetic disorder characterized by the lack of an antibody that protects against infections in the mouth, airways, and digestive tract.

IVIG should be used with caution in people with the following conditions:

  • Heart problems
  • Diabetes
  • Sensitivity to immunoglobulins
  • Sensitivity to maltose or sucrose (ingredients used in some IVIG formulations)

The only clearly defined interaction with IVIG involves live vaccines.

Immunoglobulins can render a vaccine ineffective and void any protection the vaccine may afford.

Cost

IVIG has become extremely expensive at an estimated $100 per gram. For a person weighing 154 pounds (70 kilograms), the recommended monthly dosage would end up costing around $7,000 per infusion, not including facility administration and nursing costs.

Some insurance companies may cover the cost, but it's often difficult to motivate for treatment and usually requires an appeals process to finally gain approval. If approved, insurance co-pays can be extremely high. However, some IVIG manufacturers do offer patient assistance programs (PAPs) to either defray or entirely cover the cost of treatment.

A Word From Verywell

If your doctor recommends IVIG, you may need to advocate for yourself to get approval from your insurance. It's also important to understand the benefits and limitations of the proposed treatment—essentially what the research says and doesn't say. If you're not absolutely clear about this, don't hesitate to seek a second opinion from a qualified specialist. You can use our Doctor Discussion Guide below to help you start that conversation.

Multiple Sclerosis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman
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