Intravenous Immunoglobulin Therapy for Autoimmune and Immunodeficiency Conditions

Indications and Dosage

The American College of Physicians recommends IVIG for patients with idiopathic inflammatory myopathies who present with dysphagia, significant weight loss, severe rash, or weakness, with a dose of 1-2 g/kg ideal body weight, administered over 2 consecutive days, repeated monthly for 1-6 months 1, 2
The British Journal of Dermatology suggests a dose of 2 g/kg administered in divided doses over 3 days, with cycles repeated initially every 4 weeks until remission, for patients with pemphigus vulgaris, with a strength of recommendation D and level of evidence 3 3
The European League Against Rheumatism recommends IVIG for patients with systemic juvenile idiopathic arthritis, with a dose of 1.5 g/kg every 2 weeks for 2 months, then monthly for 4 months, resulting in improvement of arthritis in 50% of patients 4

The Mayo Clinic recommends verifying serum IgA levels before administering IVIG, as IgA deficiency can lead to severe infusion reactions or anaphylaxis, and using IVIG preparations with reduced IgA levels if deficiency is detected 1, 2
The American Academy of Neurology suggests monitoring for adverse effects, such as headache, aseptic meningitis, anaphylaxis, and volume overload, and targeting IgG levels ≥400 mg/dL if hypogammaglobulinemia is present 5

The British Journal of Dermatology advises against using IVIG as monotherapy in pemphigus vulgaris without a plan for maintenance therapy, as relapses occur rapidly 3