Intravenous immunoglobulin (IVIg)

What is IVIg?

Immunoglobulins are proteins produced by the immune system (the body’s own defence system) that help to fight infection. Intravenous immunoglobulin, or IVIg, can dampen down some inflammatory diseases that involve the immune system.

IVIg is a blood product that combines immunoglobulins from several donors. The donors will have been screened to make sure that they have no serious diseases that can be passed on, for example hepatitis B, hepatitis C and HIV.

It can be used in the treatment of several different conditions including polymyositis and dermatomyositis, and is sometimes used in people with:

You may not be prescribed IVIg if you've had a previous reaction to immunoglobulin. Before you're given IVIg, your doctor will check the levels of immunoglobulin in your blood. If one particular type (called IgA) is very low, then you may not be given IVIg.

How is it taken and how long does it take to work?

IVIg is given by intravenous infusion (a drip into a vein). You’ll need to go to hospital each time you have the treatment. The infusion will take several hours as the drug has to be given slowly. The rate of the infusion will be increased during the first hour if you have no problems. You’ll be observed closely and have your blood pressure, pulse and temperature checked regularly. After the infusion has finished you’ll need to be observed for an hour to check for any side-effects.

Depending on the condition you have the infusions are given on just one day, or on 2–5 consecutive days. Some people may require repeat courses every 4 weeks. The dose will be calculated according to your body weight.

IVIg doesn’t work straight away. It may take 2–12 weeks to become effective.

Side-effects and risks

All donors of the blood from which IVIg is made are carefully screened for serious diseases that could be passed on to you. However, it's impossible to completely eliminate the risk of passing on infection.

People having IVIg may occasionally experience a reaction during or after the infusion. The symptoms of this include a chill or a fever, headache, stomach pain, nausea (feeling sick) or vomiting, joint pain (particularly low back pain) or tiredness.

If these symptoms happen during the infusion, it will be slowed down or stopped as necessary and the symptoms usually settle quickly.

If possible, you’ll be given the same brand of IVIg (e.g. Flebogamma or Octagam) each time. This is to reduce the likelihood of an infusion reaction. However, sometimes difficulties with supply of IVIg mean that another brand has to be used.

In rare cases, people having IVIg may experience:

  • a rash
  • abnormalities in liver function (detected by blood tests)
  • acute kidney failure
  • inflammation of the brain (aseptic meningitis)
  • a type of anaemia called haemolytic anaemia, which will improve over time.

All these rare side-effects can be treated.

Very rarely, people may experience a severe allergic reaction to this drug treatment. The symptoms can include chest tightness, breathing difficulties, a rash, swelling of the face or tongue, and a drop in blood pressure. If this happens, urgent medical attention is needed. If the reaction is severe, then your treatment can’t be continued.

Very occasionally, IVIg can cause a rise in blood pressure, and very rarely, it can cause increased clotting of the blood leading to an increased risk of problems such as heart attack, stroke, and blood clots in the lung (pulmonary embolism) or legs (deep vein thrombosis, or DVT).

A nurse will monitor you during the infusion but please report any new symptoms during or after the infusion. These reactions occur only in a minority of patients.

If you have any concerns about your treatment or its side-effects you should discuss these with your doctor, rheumatology nurse or pharmacist.

Effects on other treatments

IVIg may interfere with the immune response following any vaccine and this can make the vaccine less effective. Therefore it's best to avoid vaccines for at least six weeks (sometimes longer, depending on the exact vaccine) after having IVIg.

Alcohol

There's no particular reason to avoid alcohol before or after IVIg treatment.

Fertility, pregnancy and breastfeeding

Although there are no definite harmful effects to the mother or baby if IVIg is given during pregnancy, it's usually avoided because its safety isn't well established.

You shouldn't breastfeed if you're having IVIg. The immunoglobulins will be passed into the breast milk and we don't yet know what effect these may have on the baby.