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NEUROLOGY 2009;73:180-185
© 2009 American Academy of Neurology

IV immunoglobulin is associated with a reduced risk of Alzheimer disease and related disorders

H. Fillit, MD, G. Hess, MD, J. Hill, PhD, P. Bonnet, PharmD and C. Toso, PharmD

From the Alzheimer’s Drug Discovery Foundation (H.F.), New York; Mount Sinai School of Medicine (H.F.), New York, NY; SDI (G.H., J.H.), Plymouth Meeting, PA; Leonard Davis Institute (G.H.), University of Pennsylvania, Philadelphia; Baxter Bioscience (P.B.), Westlake Village, CA; and Toso Clinical Communications (C.T.), Philadelphia, PA.

Address correspondence and reprint requests to Dr. Jerrold Hill, 220 W. Germantown Pike, Suite 140, Plymouth Meeting, PA 19462 jhill{at}sdihealth.com

Objective: To compare the incidence of Alzheimer disease and related disorders (ADRD) in patients treated with IV immunoglobulin (IVIg) for non-Alzheimer disease (AD) indications vs untreated controls.

Methods: This retrospective case-control analysis used medical claims for patients ≥65 years old from a national database of 20 million age-qualified patients. Cases received ≥1 IVIg administration during April 1, 2001-August 31, 2004, had claims 1 year prior to first (index) IVIg administration to confirm absence of pre-index ADRD, and had ≥3 years of continuous claims post-index. Untreated controls had their first medical claim during April 1, 2000-August 31, 2004, and otherwise met the same requirements as cases. Controls were matched 100:1 to cases on age, gender, and risk factors for ADRD. The relative incidence of ADRD post-index for the IVIg-treated cases vs untreated controls was estimated using Kaplan-Meier survival curves and a Cox proportional hazards model.

Results: Treated patients in the Kaplan-Meier analysis had lower ADRD incidence (p = 0.02) with an estimated 2.6% of the 847 IVIg-treated vs 4.6% of 84,700 controls diagnosed with ADRD at 60 months after index date. Treated patients in the Cox proportional hazard model had a 42% lower risk of being diagnosed with ADRD (hazard ratio, 0.577; 95% confidence interval, 0.359 to 0.930; p = 0.024) with an estimated 2.8% of treated vs 4.8% of controls diagnosed with ADRD at 60 months after index date.

Conclusions: Previous treatment with IV immunoglobulin was associated with a reduced risk of developing Alzheimer disease and related disorders (ADRD) in this study. Evidence from additional studies is needed to evaluate the relationship between IVIg exposure and ADRD diagnosis.

Abbreviations: Aβ = amyloid beta; AD = Alzheimer disease; ADRD = Alzheimer disease and related disorders; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; ICD = International Classification of Diseases; IVIg = IV immunoglobulin.

Disclosure: Author disclosures are provided at the end of the article.

Received June 23, 2008. Accepted in final form April 10, 2009.






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