Overview | Schedule | Side Effects | Monitoring | Tips | Patient Assistance | Emotional Wellness | Drugs | References
Treatment Name: Immune Globulin (IVIG, IV IgG)
How does intravenous immunoglobulin (IVIG, or IV IgG) work?
In patients with ITP, Intravenous immunoglobulin (IVIG) increases the platelet count by decreasing the destruction of platelets in your spleen. IVIG may also work in patients with or without a spleen by binding to and neutralizing the antibodies responsible for destroying platelets.
IV - IntraVenous
IgG - Immunoglobulin G
Trade names for IVIG include (listed alphabetically):
- Carimune
- Flebogamma
- Gammagard
- Gammaked
- Gammaplex
- Gamunex-C
- Octagam
- Privigen
Goals of Intravenous Immune Globulin (IVIG, IV IgG) therapy for ITP:
Intravenous Immune Globulin (IVIG) is given to temporarily increase the platelet count to a level which prevents bleeding or to a level that is safe to allow the patient to have surgery. Other therapies may be needed to prevent the platelet count from decreasing back to a dangerous level.
Schedule
- Intravenous Immune Globulin (IVIG) 2 gram/kg per course, divided in multiple doses:
- IVIG 1 gram/kg/day for 2 consecutive days. If after the first of these two doses the platelet count increases to an adequate level after 24 hours, the second dose may be withheld
OR
- IVIG 0.4 gram/kg/day for 5 consecutive days, with each dose being given over several hours. This lower dose given more often may be recommended for those who have fluid overload, edema, or heart problems
Example dose: If a 70 kg person (154 lbs.) received 1 gram/kg/day for 2 days, they would receive 70 grams/day each day, for a total of 140 grams per course
- Initial and maximum infusion rate to be determined based upon exact IVIG product chosen and patient-specific risk factors for kidney dysfunction or blood clots
Estimated total infusion time for this treatment:
- Up to 24 hours for each dose; as short as several hours based upon total dose prescribed, weight of patient, and tolerability
- Infusion times with IVIG may vary considerably depending on doctor preference or patient tolerability.
- Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
When used for low platelet counts in patients with ITP, Immune Globulin (IVIG) may be given in an outpatient infusion center, allowing the person to go home afterwards. It could also require a 1 - 5 day stay in a hospital, depending upon: the response to the medication, if someone is too sick for outpatient treatment, is at a high risk for bleeding, or is currently bleeding.
Intravenous Immune Globulin (IVIG) may be repeated at various time points when chronic ITP patients have a relapse in their platelet count or require surgery.
Side Effects
Clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of Intravenous Immune Globulin (IVIG) for ITP are shown here:
Note: Although rare, severe reactions, such as hypersensitivity, have occurred in some patients receiving intravenous immune globulin products. IVIG should be discontinued immediately and acute hypersensitivity support care medications such as epinephrine may need to be given. Patients with a known condition of "IgA deficiency" may be at higher risk for hypersensitivity reactions.
In two clinical trials that studied IVIG use in patients with ITP, 2 out of 76 patients (~3%) discontinued IVIG due to the following side effects: hives and headache + fever + vomiting.
Monitoring
How often is monitoring needed?
Labs (blood tests) may be checked before treatment, periodically thereafter until stable. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.
How often is imaging needed?
Imaging is rarely needed for patients with ITP as blood tests are commonly used to monitor response to therapy. Imaging may be checked if there is a suspicion of bleeding, blood clots, or lung injury. infection, such as pneumonia. Depending upon the reason for imaging, your doctor may order one or more of the following: CT scan, Ultrasound, chest x-ray, or others.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue Intravenous Immune Globulin (IVIG) as planned, discontinue when treatment is complete, delay the next dose until a side effect goes away, or switch to an alternative therapy.
Depending upon your doctor's recommendation, if the BUN/SCr increase (markers of kidney function found on a CMP), the infusion duration may be prolonged or the dose may be held until kidney function returns to baseline.
Questions to Ask Your...
A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!
Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.
ChemoExperts Tips
- Response rates to IVIG vary considerably in patients with ITP. In one clinical study, IVIG increased the platelet count from less than 20 k/uL to more than 50 k/uL within 7 days in 90% of patients. This response was sustained for 7 or more days in 74% of patients. Your doctor may recommend additional ITP therapy in case IVIG does not work or stops working
- Not all IVIG products are indicated for the treatment of ITP and may not have insurance coverage. Additionally, not all IVIG products are considered interchangeable. Ask your doctor or pharmacist for more information. Some IVIG products may not be ideal for patients with kidney problems. In general, IVIG products that do not contain sucrose are preferred for patients with kidney problems
- Aseptic meningitis syndrome (AMS) (symptoms may include: severe headache, neck stiffness, confusion, drowsiness, fever, increased sensitivity to light known as photophobia, nausea or vomiting) may occur infrequently, with the risk increasing for high doses or rapid infusions. If it occurs, aseptic meningitis usually resolves on its own without lasting side effects. If aseptic meningitis occurs, the infusion should be stopped until the symptoms go away. For future doses, the rate should be slowed. Corticosteroids such as prednisone taken as a pre-medication (or to treat ITP) may help to prevent future episodes of aseptic meningitis
- To prevent decreased kidney function, it is important to ensure adequate hydration on the days you are receiving intravenous immune globulin
- Intravenous immune globulin may interfere with the immune response to live vaccines, such as measles, mumps and rubella (MMR). Talk to your doctor or pharmacist about this interaction if it is recommended that you receive live vaccines after receiving IVIG
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for ITP. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications.
- If you are looking for patient assistance or co-pay coverage for medications in the IVIG regimen, we have provided links to PAN Foundation or PSI, which may offer financial assistance
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Immune Globulin (IVIG, IV IgG), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Immune Globulin (IVIG, IV IgG). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Immune Globulin (IVIG, IV IgG) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
Emotional Wellness
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Immune Globulin (IVIG, IV IgG)
