IVIG Therapy: How It Works and What to Expect (2024)

Intravenous immunoglobulin (IVIG) is a type of medication used to treat people with immunodeficiencies, when the immune system functions poorly. It is made from human blood plasma and is, therefore, known as a biologic drug product.

Immunodeficiencies can increase the risk of infection and cause illnesses, nerve damage, muscle weakness, blood abnormalities, and more. Administering IVIG products to these individuals aims to normalize their immune systems and relieve these symptoms.

This article reviews IVIG therapy, its uses, how it works, and what to expect when receiving it.

Immunoglobulins and IVIG

Immunoglobulins are also known as antibodies. They are proteins that are produced by your blood when your body detects antigens.

Antigens are foreign or outside substances your body doesn’t recognize, such as bacteria, viruses, and chemicals and other toxins. Immunoglobulins attach to these foreign substances, which helps your other immune cells destroy them.

The ability to recognize and form a response to these foreign bodies depends on your immune system functioning properly, and making immunoglobulins is part of that. When a person’s immune system is not working as well as it should, they are said to be immunocompromised, which can happen in various health conditions.

IVIG therapy is made by isolating immunoglobulin proteins from donated blood and plasma of other people. Most manufacturers of IVIG therapy use tens of thousands of healthy donors to continue producing pure and safe IVIG products.

Uses of IVIG Treatment

IVIG is used for conditions in which the immune system is compromised or when the body doesn't make enough antibodies. These conditions are characterized by low immunoglobulin levels and may affect both adults and children.

Some of the most common indications for IVIG are:

• Primary immunodeficiency (PI) in adults and children 2 years and older: PI encompasses many diseases associated with a weakened immune system. It drastically increases the risk and severity of illnesses and infections.
• Multifocal motor neuropathy (MMN): This is a rare immune-mediated disorder that causes muscles to shrink and weaken over time. IVIG can help improve muscle strength.
• Chronic inflammatory demyelinating polyneuropathy (CIDP): CIDP is caused by an immune response that damages the myelin sheaths protecting your nerve fibers. This can lead to weakness and impaired sensation in your arms and legs.
• Idiopathic thrombocytopenic purpura (ITP) in adults and children: ITP is a condition in which the body’s immune system destroys its own platelets, which are important for blood-clotting. This condition results in an increased risk of bruising and bleeding.
  

What to Expect When Receiving IVIG Therapy

IVIG therapy is given as an IV infusion. This means a healthcare professional will start an IV line, typically in your arm, and the medication will be run through the thin tube into your bloodstream.

You may initially feel a prick and a bit of pain, but otherwise, the infusion should be pain free.

IVIG is typically given in supervised outpatient settings, such as health clinics or infusion suites. It may also be given in the hospital. You can receive infusions at home as well, supervised by a home healthcare practitioner such as a nurse. This is more likely to occur once you have had three or four successful infusions in a supervised setting without any issues.

How long an IVIG infusion takes depends on the dose, the number of infusions being received, and the drugs being given, but a common range is one to four hours.

Side effects from the infusion tend to be more likely if it is given at a faster rate, so it will be transfused slowly to start, especially if you are new to IVIG. Bringing an activity like a book to read or your phone to catch up on TV or movies can help pass the time quicker.

Once you tolerate a slower rate, it can be increased at intervals of about 30 minutes to an hour. Once you’ve had several successful infusions without any reactions, your infusion may take just one to two hours.

Many people are on IVIG indefinitely, but the good news is that most IVIG products only need to be infused around once every few weeks, so they should not take up too much of your time overall.

Side Effects of IVIG

IVIG is widely used and tolerated well in general, but there are potential side effects.

Most side effects—particularly immediate reactions that occur within the first 30 minutes to an hour of the infusion starting—are mild and subside once an IVIG infusion is stopped or slowed down. These include:

• Flushing
• Headache
• Malaise
• Fever
• Chills
• Fatigue
• Lethargy

Side effects may occur during your first infusion, but they’re also possible on subsequent infusions as well. This is why your infusions are supervised by a medical practitioner.

Other delayed reactions are much more rare but can be serious, such as:

• Kidney impairment
• Thrombosis (clot in a blood vessel)
• Arrhythmia (abnormal heart rhythm)
• Aseptic meningitis (inflammation of membranes in the brain)
• Hemolytic anemia (red blood cells are destroyed faster than can be replaced)
• Lung injury

When to Contact a Healthcare Provider

You will not be receiving IVIG therapy without a healthcare practitioner being present, but some symptoms to look for that require the immediate attention of the administering practitioner include signs of a potentially life-threatening allergic reaction called anaphylaxis, which are:

• Chest tightness or difficulty breathing
• Swelling of your tongue or face
• Skin reaction like a rash
• Sudden drop in blood pressure (which can leave you feeling faint or light-headed).

Along with ordering IVIG, your prescribing provider typically includes prescriptions for other medications that can help with infusion reactions. Home health nurses helping you with your infusion at home will typically follow a protocol for infusion reactions.

These steps typically involve stopping or slowing the IVIG infusion and administering one or more infusion reaction medicines such as an EpiPen (epinephrine) or Benadryl (diphenhydramine), notifying your prescribing provider of the reaction, and calling emergency medical services if the reaction does not resolve.

Is IVIG Therapy Effective?

Many studies have demonstrated that IVIG is an effective, safe, and tolerable treatment that helps restore the immune system in people with immunodeficiencies. For most of these conditions, it is considered standard therapy.

Studies evaluate how well IVIG works in treating primary immunodeficiency by tracking the number of serious bacterial infections that occur, such as:

• Bacterial pneumonia (lung infection)
• Bacteremia (blood infection)
• Meningitis (an infection in the brain)
• Osteomyelitis (bone infection)

In one study, people who received a new IVIG product every three to four weeks were evaluated for one year. The results showed:

• Just 2% of people experienced one serious bacterial infection, which was pneumonia.
• Of the total number of infusions, 22% were associated with mild or moderate side effects, most commonly a headache.
• More than 98% were completed without discontinuation or having to reduce the infusion rate due to side effects.

Another study looked at how effective IVIG therapy was for CIDP. Participants received an IVIG or placebo infusion every three weeks. Disability was measured at 24 weeks. The results showed:

• The percentage of people who had improved disability was significantly higher in the IVIG group (54%) compared to the placebo group (21%). This included improvements in muscle strength and grip strength.
• Of the IVIG group, 60% experienced full benefits of the drug after six weeks.
• The IVIG group also reported significant improvements in physical and social functioning and mental health.

Alternatives to IVIG

While IVIG is widely considered a safe and effective treatment, not everyone is a candidate due to cost, logistical hindrances, or shortages of immunoglobulin availability.

Some potential alternatives that may be appropriate for certain conditions normally treated with IVIG include:

• Monoclonal antibodies (mAbs) are proteins produced in a lab that mimic natural antibodies. They are made into immunotherapy medications and are often used to help your immune system fight against cancer. Examples include Rituxan (rituximab), Herceptin (trastuzumab), and Keytruda (pembrolizumab).
• Hematopoietic stem cell transplant (HSCT), a type of bone marrow transplant, is a procedure that involves taking stem cells from a healthy donor and transferring them to someone who is immunocompromised. Stem cells produce all other types of cells, including those needed for a functional immune system. Receiving a transplant with these healthy stem cells can help fix an impaired immune system.
• Plasma exchange (also called plasmapheresis) is a procedure in which your blood plasma is cycled through a machine and replaced with plasma from immunocompetent donors (people who do not have immune-related conditions). Efficacy rates seem to be comparable to IVIG for most indications. However, IVIG is often considered more convenient in comparison to plasma exchange.
• SCIG, or subcutaneous immunoglobulin, is very similar to IVIG but injected just underneath your skin. Studies have shown equal or better results compared to IVIG, with fewer side effects. SCIG can often be done at home rather than in an outpatient infusion center.

Summary

Intravenous immunoglobulin, or IVIG, is made from the blood of thousands of healthy donors. It isolates antibodies from donor blood and can be given directly into the bloodstream of individuals with immunodeficiencies—conditions in which the immune system is less able to fight off infections.

You can expect to receive an IVIG infusion at an outpatient clinic, a medical provider’s office, or in your own home with a healthcare provider supervising the infusion.

IVIG is an effective treatment against immunodeficiencies and is generally well tolerated with mild or moderate side effects such as headache, flushing, chills, or fatigue. These side effects can often be avoided or minimized with premedications or by slowing down the infusion rate of the IVIG.