Intravenous Immunoglobulin Treatment in Chronic Neurological Diseases: Do We Have Maintenance Dose Right?

الملخص EN

|Objectives.

We tried to define, on individual basis, minimal effective maintenance dose of intravenous immunoglobulins (IVIG) in 26 patients with chronic neurological conditions requiring long-term IVIG treatment.

Methods.

Clinical criteria were reviewed in individual cases (Phase 1) followed by titration phase (Phase 2, 12 months) and posttitration/follow-up phase (Phase 3, 3 months).

Objective neurological examination and patient self-reports were used for clinical follow-up.

Results.

69.2% of patients reported condition as stable, 26.9% as better, and 3.9% as mildly worse.

Original mean monthly dose was 1 g/kg; over the period of 12 months we reduced dose of IVIG to mean dose 0.67 g/kg (range 0.3–2.5 g/kg, P<0.0001) which meant reduction by 36.4%.

We identified 4 nonresponders and diagnosis in one case was reclassified to degenerative disease.

In follow-up phase we reduced dose further to 0.60 g/kg.

Cumulative monthly dose dropped from 2040 g to 1298 g and to 991 g, respectively.

Financial expenses were reduced significantly (by −36.4% during titration phase and by −51.4% during follow-up phase) (comparing with baseline) (P<0.0001).

Conclusion.

Individual dose titration leads to significant maintenance IVIG dose reduction with preserved clinical efficacy.

Maintenance dose below 1 g/kg (in our study around 0.7 g/kg) has acceptable risk/benefit ratio.