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IVIG for CIDP

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Patient who receives IVIG for CIDP

IVIG for CIDP

Intravenous immunoglobulin (IVIG) is a safe, FDA-approved, and efficacious treatment therapy for chronic inflammatory demyelinating polyneuropathy (CIDP). CIDP is a long-term chronic neurological disorder that worsens over time and affects around 5 to 7 out of 100,000 individuals.

 

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In CIDP, abnormal immune cells attack the healthy cells, specifically the myelin sheath of peripheral nerves (neurons), and this can lead to functional disabilities (muscle weakness, slow nerve conduction, and loss of sensation) in patients.

There is no specific cure for CIDP, but immunoglobulin treatment has been used as first-line therapy to ease CIDP symptoms and lessen complications over the last two decades.

 

IVIG Mode of Action

In IVIG therapy, healthy immunoglobulins (antibodies) extracted from the donors’ plasma are rapidly infused into the veins of CIDP patients. These healthy antibodies prevent the immune cells from attacking and destroying the myelin sheath of peripheral nerves. 

The detailed working mechanism or therapeutic effects of IVIG in CIDP is not precisely known; however, it is thought that different modes of action are involved. 

 

Standard IVIG Dose for CIDP Patients

Based on several clinical studies, the standard IVIG dosage for CIDP treatment is 2 g/kg or (20 ml/kg) with an infusion duration of 3 to 5 hours. This initial loading dose is administered intravenously for over 2 to 5 days, followed by a maintenance dosage at around 1 g/kg or (10 ml/kg) over 1 day every 3 to 4 weeks [1].

In younger CIDP patients, IVIG is administered at 1g/kg or (1ml/kg) over 4 to 6 hours for 2 days.

In some cases, the standard IVIG dose can be ineffective for some patients; therefore, higher or repetitive IVIG infusions are often considered to achieve sufficient effectiveness. For instance, in some severe and persistent CIDP cases, patients who don’t respond well to the standard dose are treated with a high IVIG dose of 3 g or 30 ml/kg/month for 5 consecutive days [2]. 

However, the next dose could vary depending on the patient’s health status, degree of treatment response to immunoglobulins, and improvement in CIDP symptoms.

 

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IVIG Success Rate in CIDP

Smiling woman with improved CIDP symptoms after IVIGThe main goal of IVIG for CIDP treatment is to substantially reduce the patient’s symptoms, improve their body’s functional ability, prevent relapse, and maintain long-term remission. Unlike standard CIDP treatments such as corticosteroids and plasmapheresis (plasma exchange), IVIG has a more rapid response and high success rate. Improvement in CIDP symptoms can be seen within one month after IVIG infusions.

Several clinical studies have reported the IVIG success rate in CIDP patients. A randomized controlled trial conducted on 117 CIDP individuals demonstrated that 54% of the patients on IVIG treatment showed improved functional disability at 24 weeks compared to the placebo rate of 21%. Moreover, 60% of patients showed maximal IVIG response by 6 weeks, and significant improvement in muscle strength and grip strength was also observed.

Similarly, a systematic review of five clinical trials conducted on a total of 235 CIDP subjects has shown that patients who have received IVIG treatment showed improvement in disability compared to placebo.

Based on clinical evidence, IVIG is an effective, well-tolerated treatment and has shown promising results in treating CIDP. IVIG can also be used long-term due to its low rate of long-term side effects. 

 

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REFERENCES:

  1. Cornblath, D. R., Van Doorn, P. A., Hartung, H. P., Merkies, I. S., Katzberg, H. D., Hinterberger, D., & Clodi, E. (2022). Randomized trial of three IVIg doses for treating chronic inflammatory demyelinating polyneuropathy. Brain145(3), 887-896.
  2. Seino, Y., Nakamura, T., Hirohata, M., Kawarabayashi, T., Okushima, T., & Shoji, M. (2019). Severe chronic inflammatory demyelinating polyneuropathy ameliorated following high-dose (3 g/kg) intravenous immunoglobulin therapy. Internal Medicine, 1723-18.
  3. Oaklander AL, Lunn MP, Hughes RA, van Schaik IN, Frost C, Chalk CH. Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overview of systematic reviews. Cochrane Database Syst Rev. 2017;1:Cd010369. 
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