Safety of intravenous immunoglobulin in the elderly treated for a dysimmune neuromuscular disease

Muscle Nerve. 2016 May;53(5):683-9. doi: 10.1002/mus.24942. Epub 2016 Jan 19.

Abstract

Introduction: Many patients treated with intravenous immunoglobulin (IVIg) are >60 years of age. Tolerability has yet to be demonstrated in this age group.

Methods: This is a retrospective study of adverse reactions among consecutive patients treated with IVIg for neurological disorders. Risk factors were recorded. Correlation and relative risks were calculated for age, risk factors, IVIg course, daily dose, concentration, preparation, and duration of treatment. An infusion and monitoring protocol was applied.

Results: Two hundred forty-four patients were reviewed, including 62% who were ≥60 years of age (total dose 1.8 ± 0.4 g/kg body weight, daily dose 30.3 ± 2.0 g). Sixty-nine percent received sugar-stabilized IVIg. Forty-nine percent presented with >1 risk factor. Adverse reactions occurred in 35% and led to treatment discontinuation in 5%, with a similar incidence among age groups. In patients ≥60 years old, sucrose-free IVIg administration was an independent predictor of adverse reactions, including renal failure.

Conclusion: In the elderly, IVIg infusions are safe. Adverse reactions mainly depend on IVIg preparation and administration. Renal failure is not uncommon with sugar-free IVIg.

Keywords: CIDP; dose; elderly; intravenous immunoglobulin; side effect; sucrose.

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Comorbidity
  • Diabetes Mellitus / epidemiology
  • Drug Eruptions / etiology
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Female
  • Guillain-Barre Syndrome / drug therapy
  • Guillain-Barre Syndrome / epidemiology
  • Headache / chemically induced*
  • Heart Failure / epidemiology
  • Humans
  • Hypertension / chemically induced*
  • Hypertension / epidemiology
  • Immunoglobulins, Intravenous / adverse effects*
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunologic Factors / adverse effects*
  • Immunologic Factors / therapeutic use
  • Male
  • Middle Aged
  • Myasthenia Gravis / drug therapy
  • Myasthenia Gravis / epidemiology
  • Neuromuscular Diseases / drug therapy*
  • Neuromuscular Diseases / epidemiology
  • Overweight / epidemiology
  • Paraproteinemias / epidemiology
  • Peripheral Nervous System Diseases / drug therapy
  • Peripheral Nervous System Diseases / epidemiology
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / drug therapy
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / epidemiology
  • Renal Insufficiency, Chronic / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Venous Thrombosis / epidemiology
  • Young Adult

Substances

  • Immunoglobulins, Intravenous
  • Immunologic Factors