IVIG, SCIG Help Treat Immunodeficiency Disorders

Saro Arakelians, PharmD

It is important for health care providers to explain compliance to these regimens to patients, both from a clinical and cost perspective.

The human body’s immune system normally makes antibodies to fight germs and infections.

When the immune system is compromised or an individual experiences immune deficiency, the body cannot fight such germs and infections, creating a higher risk of contracting severe immunologic and infectious diseases. But immune globulin, such as intravenous (IVIG) and subcutaneous (SCIG) can help treat autoimmune and immune system disorders.¹

Immunoglobulins are a part of the body’s natural plasma, which consist of antibodies that can fight diseases and germs. Such immunoglobulins can be separated from the blood and stored to be used for patients in need. Additionally, the immunoglobulins can help restore the body’s power to fight against germs and infections. Immunoglobulin classes of antibodies found in the serum include IgA, IgD, IgE, IgG, and IgM.¹

Immunoglobulins are infused into a patient’s veins. The health care provider, such as the nurse, uses a needle to enter the vein, which helps with creating pathways to flow the immunoglobulin from the bag to the patient’s arm. Depending on various immunoglobulins, the infusion may take 2 to 4 hours on average. The infusion can take place in a clinic, hospital, infusion center, or physician’s office. Home infusion can occur if a nurse or another medical professional visit a patient to provide the dose. This type of treatment must be continued every few weeks to keep the immune system strong and allow it to fight germs and infections.¹

IVIG, which was first used in 1952, is prepared from several thousands of healthy donors and contains natural antibodies (Nab). Such therapy is the standard therapy for immunodeficiency disorders, such as common variable immunodeficiency, primary immunodeficiency (PID), X-linked agammaglobulinemia (XLA), x-linked hyper-immunoglobulin (Ig)M, and selective IgG class deficiency disorders.²

Aside from IVIG and SCIG, immune globulins include animal-derived immune globulin products, hyperimmune globulin, and intramuscular immune globulin.³

Examples of IVIGs include Asceniv, Bivigam, Carimune, Gammagard Liquid, Gammagard S/D, Gammaked, Gammaplex, Gamunex, Flebogamma, Octagam, Panzyga, and Privigen. Examples of SCIGs include Cutaquig, Cuvitru, Gammagard liquid, Gammaked, Gamunex-C, Hizentra, Hyqvia and Xembify. Examples of animal-derived immune globulin products include Atgam, ANAVIP, Digifab, and Thymoglobulin. GamaSTAN S/D is an example of an intramuscular immune globulin, while examples of hyperimmune globulins are CytoGam and Varizig.³

Most of these immunoglobulins come in liquid form and must be stored in various temperatures, based on the package insert information. The immunoglobulins mentioned previously can be used for primary immunodeficiency disorders, whereas others can be used for chronic inflammatory demyelinating polyneuropathy and immune thrombocytopenic purpura. Some may be dosed starting at 0.01 ml/kg/min, to 0.5mg/kg/min or 1mg/kg/min based on body weight.⁴

Some patients experience adverse effects from IVIG including chills, fatigue, fever, flu-like symptoms, headaches, joint pain, nausea, rash, or vomiting. These symptoms are usually mild and only occur during the first dose introduced to the body.

Health care providers may conduct a few laboratory screenings before starting IVIG, and it is important that patients stay well hydrated during the process. Some providers may divide the dosages into smaller increments over several days to minimize the number or severity of the adverse effects. Taking acetaminophen or non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen, can help manage adverse effects.⁵

Conclusion

The list of IVIGs is growing, from gamimune to the most recent ones approved in 2021, such as Panzyga. This is promising news for patients to not only have access to various types of IVIG but different options when administering these medications. Health care providers should explain the importance of compliance to such regimens, both from a clinical and cost perspective.

References

  • Katz J. Intravenous immunoglobin. Medscape. July 5, 2018. Accessed June 7, 2021. https://emedicine.medscape.com/article/210367-overview
  • Kaveri SV, Maddur MS, Hegde P, Lacroix-Desmazes S, Bayry J. Intravenous immunoglobulins in immunodeficiencies: more than mere replacement therapy. Clin Exp Immunol. 2011;164 Suppl 2(Suppl 2):2-5. doi:10.1111/j.1365-2249.2011.04387.x
  • Immune Globulins. FDA. July 1, 2020. Accessed June 3, 2021. https://www.fda.gov/vaccines-blood-biologics/approved-blood-products/immune-globulins
  • Immune globulin reference chart. FFF Enterprises. 2019. Accessed June 3, 2021. https://www.fffenterprises.com/assets/downloads/FFF_ReferenceChart-ImmuneGlobulin-IG.pdf
  • Shehata N. Patient education: intravenous immune globulin (IVIg) (beyond the basics). UpToDate. Updated February 25, 2021. Accessed June 3, 2021. https://www.uptodate.com/contents/intravenous-immune-globulin-ivig-beyond-the-basics