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Intravenous gammaglobulin (IVIg) for treatment of CIDP and related immune-mediated neuropathies

From the Peripheral Neuropathy Center, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY.

Address correspondence and reprint requests to Dr. Thomas H. Brannagan, III, Peripheral Neuropathy Center, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, 635 Madison Ave., Suite 400, NewYork, NY 10021.

Intravenous immune globulin (IVIg) is considered an effective and safe treatment for autoimmune neuropathies, especially in comparison to the alternative treatments such as corticosteroids, chemotherapy, and plasmapheresis. Patients are frequently given a standard induction dose of 2 g/kg, which may be followed by maintenance therapy as needed. Mild infusion-related reactions are frequent but these can often be controlled by slowing the infusion rate or by symptomatic medications. Serious adverse effects are rare and can include thromboembolic events, renal failure, anaphylaxis, or septic meningitis. Patients with IgA deficiency are at risk for anaphylaxis. Immobility, increased serum viscosity, and preexisting vascular disease can increase the risk for thromboembolic events. Preexisting renal insufficiency or the use of sucrose-containing IVIg preparations can increase the risk for renal failure, and patients with migraine are at risk for development of aseptic meningitis. Screening patients for risk factors that predispose to development of adverse events may reduce the incidence of complications.

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