Multiple Sclerosis (MS) is an autoimmune disease affecting the central nervous system, where the body’s immune system attacks the protective myelin sheath on nerve fibers. This damage disrupts communication between the brain and the rest of the body. Intravenous Immunoglobulin (IVIG) is a therapy created from pooled antibodies from the plasma of thousands of healthy donors. While not a primary treatment, IVIG is sometimes used in specific situations to help manage the condition.
The Mechanism of IVIG in Multiple Sclerosis
The precise way IVIG works in MS is not fully established, but its action is believed to be multifactorial. The therapy introduces a broad range of antibodies into the patient’s system. These antibodies are thought to help normalize the immune system by interfering with the harmful antibodies attacking the myelin sheath.
A leading theory is that IVIG suppresses the autoimmune response by neutralizing damaging autoantibodies and reducing inflammatory cytokines—proteins that signal immune cells to cause inflammation. IVIG may also inhibit specific immune cells, like B and T cells, preventing them from producing the autoantibodies that damage nerve tissues.
Some evidence suggests IVIG may also promote the repair of damaged myelin, a process called remyelination. By calming the immune assault and aiding in the restoration of the nerve coating, IVIG aims to reduce the frequency of relapses and slow the progression of disability.
Clinical Application in MS Treatment
The use of IVIG for MS is considered an “off-label” application, as it has not been approved by the U.S. Food and Drug Administration (FDA) for this disease. Clinicians may use IVIG in specific circumstances where other treatments are not suitable or have failed. Its application is reserved for exceptional cases rather than routine treatment.
One scenario for using IVIG is in managing acute MS relapses. It is considered a third-line option after treatments like intravenous steroids and plasma exchange have proven ineffective or cannot be used. For instance, if a patient with a severe relapse does not respond to standard steroid therapy, IVIG may be administered.
IVIG is a therapeutic option for women with MS who are pregnant or in the postpartum period. Many standard disease-modifying therapies (DMTs) are not recommended during pregnancy due to potential risks to the fetus. IVIG is considered a safer alternative to manage disease activity and help prevent the increased risk of relapse after delivery.
Another clinical use is for patients who cannot tolerate standard DMTs. These first-line treatments can have significant side effects for some individuals. In such cases, IVIG may serve as an alternative to help manage the disease and reduce relapse rates, especially in the relapsing-remitting form of MS.
The IVIG Infusion Process
IVIG therapy is administered intravenously in a clinical setting. Patients receive infusions at a hospital outpatient unit, an infusion center, or sometimes through a home health service. The solution is delivered slowly through a tube and a needle placed into a vein.
A single infusion session lasts between two to four hours. The frequency and dosage vary depending on the clinical goal. For an acute relapse, a common regimen involves daily infusions for about five days. For maintenance therapy, infusions are given less frequently, such as once every four to six weeks.
To minimize infusion-related reactions, providers may administer pre-medications like acetaminophen or antihistamines. Throughout the infusion, a healthcare professional monitors the patient for any immediate side effects or reactions.
Potential Side Effects and Risks
IVIG carries a risk of side effects, often related to the infusion. Common, milder reactions are manageable and may be lessened by slowing the infusion rate or with pre-medications. These include:
- Headaches (the most frequent side effect)
- Flushing of the skin
- Fatigue
- Chills
- Fever
- Muscle aches
Less frequently, more serious risks can occur. One is aseptic meningitis, an inflammation of the brain and spinal cord membranes not caused by infection, with symptoms like a severe headache, stiff neck, and light sensitivity. There is also a risk of kidney problems, like acute renal failure, which is a greater concern for older patients or those with pre-existing kidney disease.
Another uncommon risk is an increased likelihood of thromboembolic events, or blood clots, which can occur in veins or arteries. To mitigate serious risks, healthcare providers screen patients for underlying conditions that might increase their risk. A slow infusion rate is another strategy used to enhance safety.