Side effects of intravenous immunoglobulins in neurological autoimmune disorders

Abstract

The increased use of intravenous immunoglobulins (IVIg) in the treatment of neurological autoimmune diseases has led to more awareness of adverse reactions. We studied prospectively the side effects of IVIg during 84 treatment courses with a total of 341 infusions under routine clinical conditions. Mild reactions were common. Headache was noted most often, occurring during 30% of treatment courses. There were three severe adverse events (3.6% of all treatment courses) that led to discontinuation of the treatment, namely thrombosis of the jugular vein, allergic reaction and retrosternal pressure. Significant changes in laboratory findings were seen for leucocytes, erythrocytes, haematocrit, haemoglobin, ALAT and ASAT. None of these changes were clinically relevant. The elevation of liver enzymes was dependent on the IVIg preparation used, while there was no association with the underlying disease, age, or gender of the patient. In conclusion, this prospective study confirms the high frequency of mild, self-limited side effects of IVIg. Elevation of liver enzymes may possibly be associated with certain IVIg preparations. Bearing these complications in mind, this prospective study supports the notion that IVIg can generally be regarded as safe, leading to severe adverse events during only 3 (0.9%) of 341 infusions (or 3 of 84 treatment courses, 3.6 %). However, careful monitoring for severe side effects remains mandatory, and we propose that laboratory findings like full blood count, renal and liver function should be monitored routinely.

Side Effects of Combined Therapy of Methylprednisolone and Intravenous Immunoglobulin in Guillain-Barré Syndrome

“…Leukopenia develops in some patients treated with IVIg [6, 10], but we did not find it in the patients in our combined therapy group. Because steroids have the potential to induce leukocytosis, the addition of methylprednisolone might prevent reduced WBC counts.…”

“…Another report on the side effects caused by IVIg given for neurological disorders found a significant elevation of liver enzymes after treatment [6]. Abnormal elevation depended on the IVIg preparation used (Alphaglobin ® , Sandoglobulin ® or Venimmun ® ), whereas there was no association with the underlying disease, age or gender.…”

Case-control study of thromboembolic events associated with IV immunoglobulin

“…Clinical trials of IVIg report a lower incidence of TE events [3,5,6], but the median age of patients in those trials was much younger and the prevalence of CV risk factors lower than in our sample. Series of patients treated with IVIg for a variety of indications [4,10,11,15] also report a lower incidence of TE events but usually include much younger patients and the means of event ascertainment is often not provided. The higher frequency of events in our study and that of Marie et al may be due to better ascertainment of cases, older age of the patient samples, and higher prevalence of CV risk factors.…”

Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy

“…13,14,[24][25][26][27][28][29][30][31][32] However, the extent to which these events are attributable to the IVIg itself rather than other risk factors is unclear, as is the risk associated with low doses of IVIg for immunodeficiency. In this retrospective cohort study, we assessed rates of clinically serious arterial and venous TEEs in older patients with CLL or MM who initiated IVIg therapy.…”