Safety of intravenous immunoglobulin in the elderly treated for a dysimmune neuromuscular disease

Abstract

In the elderly, IVIg infusions are safe. Adverse reactions mainly depend on IVIg preparation and administration. Renal failure is not uncommon with sugar-free IVIg.

A Retrospective Observational Study of Adverse Reactions Associated With Intravenous Immunoglobulin Infusion

“…In particular, the likelihood of ARs to IVIG correlated with having neuromuscular diseases (odds: 6.914) among patients with any autoimmune disease. In fact, in that subgroup, the incidence of ARs for neuromuscular diseases was 28.4% (data not shown), consistent with other studies ( 12 , 14 , 21 ) that have reported ARs in more than 20% of patients with neuromuscular diseases. Wietek et al ( 22 ) analyzed data from 112 patients with ITP receiving IVIG, in which there were five cases with at least one AR.…”

Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overview of systematic reviews

“…In a parallel-group RCT involving 27 participants, there was no significant difference in efficacy or side-effect profile of two different brands of IVIg (Kuitwaard 2010). In a retrospective review of 244 people with neurological conditions, of whom the majority were older than 60 years, the rate of adverse effects with IVIg was 35% (Lozeron 2016). Most of these adverse effects were transient hypertension and headache, but acute renal dysfunction and venous thrombosis occurred in 2%.…”

Recent advances in use of fresh frozen plasma, cryoprecipitate, immunoglobulins, and clotting factors for transfusion support in patients with hematologic disease

“…The mechanism is likely osmotic nephrosis, where tubular cells absorb the large sugar load, become vacuolated, swell, and develop tubular nephropathy [83] . This can be minimized through the selection of sucrose-free IVIG if available and if not, infusion of the product at ≤3 mg sucrose/kg/min or use of lower concentrated product (ie, 5%), dividing the dose to 500 mg/kg/day [84] . Case reports suggest that IVIG-induced hemolysis from a sucrose-free IVIG product led to pigment-induced nephropathy and may be an unrecognized cause of acute kidney injury as well [85] .…”