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  • Review Article
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Intravenous immunoglobulin therapy in rheumatic diseases

Nature Reviews Rheumatology volume 7, pages 349–359 (2011)Cite this article

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Abstract

Prepared from the collective plasma of several thousand people, therapeutic intravenous immunoglobulin (IVIg) consists mostly of human polyspecific IgG. In addition to its use in primary and secondary immune deficiencies, IVIg is used in the treatment of several rheumatic conditions, including Kawasaki disease, dermatomyositis and antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis. In these diseases, IVIg therapy generally involves the use of 2 g/kg administered over either 2 or 5 consecutive days. However, dosage regimens have not been thoroughly explored, and indications for IVIg in most rheumatic diseases, such as systemic lupus erythematosus, polymyositis and catastrophic antiphospholipid syndrome, derive from its off-label usage. Randomized clinical trials are warranted to support the evidence-based use of IVIg, and to identify the ideal administration protocols to maximize the benefits of what is a limited resource. Further research to improve the therapeutic application of IVIg relies essentially on the conception of next-generation immunoglobulin preparations and optimization of combined therapies with immunomodulatory drugs and biologic agents.

Key Points

  • Intravenous immunoglobulin (IVIg)—polyspecific IgG extracted from the plasma of >1,000 healthy blood donors—is used to treat autoimmune and systemic inflammatory diseases including several rheumatic conditions

  • At present, 2 g/kg IVIg administered over either 2 or 5 consecutive days is the commonly practiced regimen, but a proper evidence base for this dosage is lacking

  • Randomized clinical trials are warranted for identifying the optimum dose regimen, frequency of administration and window of treatment, and to support the evidence-based use of IVIg in off-label indications

  • Preliminary studies suggest that a subcutaneous route of administration of immunoglobulin (SCIg) presents with practical advantages compared with IVIg

  • More information about the mechanisms of action of IVIg might enable the rational use of particular IVIg (or SCIg) preparations in rheumatic diseases

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Figure 1: Pharmacokinetics of IVIg.

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Acknowledgements

The authors' research activities are supported by grants from the Indian Council of Medical Research (VSN), Institut National de la Santé et de la Recherche Médicale (INSERM), Center National de la Recherche Scientifique (CNRS), Université Pierre et Marie Curie and Université Paris Descartes (J. B. and S. V. K.) and the European Community's 7th Framework Program [FP7-2007-2013] under Grant Agreement N° HEALTH-F2-2010-260338-ALLFUN (J. B.). Due to space limitations, we could not cite all relevant published work; we do not mean to undermine the value of uncited studies.

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  1. Institut National de la Santé et de la Recherche Médicale Unité 872 (INSERM U872), Université Pierre et Marie Curie and Université René Descartes, 15 rue de l'Ecole de Médicine, Paris, F-75006, France

    Jagadeesh Bayry & Srini V. Kaveri

  2. Department of Clinical Immunology, Jawaharlal Institute Postgraduate Medical Education & Research, Puducherry, 605006, India

    Vir Singh Negi

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  1. Jagadeesh Bayry
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All authors contributed equally to researching data, discussing content and writing the article, and reviewing/editing of the manuscript before submission.

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Correspondence to Srini V. Kaveri.

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Competing interests

The research activities of J. Bayry and S. V. Kaveri are supported by grants from Laboratoire Français du Fractionnement et des Biotechnologies, Octapharma, Talecris and CSL Behring.

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Bayry, J., Negi, V. & Kaveri, S. Intravenous immunoglobulin therapy in rheumatic diseases. Nat Rev Rheumatol 7, 349–359 (2011). https://doi.org/10.1038/nrrheum.2011.61

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