IG Utilization Updates At A Glance

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RecommendationsIVIG is recommended for:
  • ADEM unresponsive to steroid therapy or where steroids are contraindicated.
  • Recurrent or multiphasic ADEM unresponsive to steroid therapy or where steroid therapy is contraindicated or has become intolerable.
For patients with relapsing ADEM, alternative diagnoses should be considered, including multiple sclerosis (MS), myelin oligodendrocyte glycoprotein antibody disorder (MOGAD), or neuromyelitis optica spectrum disorder (NMOSD), and other therapies may be offered as applicable.
Dose/Frequency of AdministrationInduction: 2 g/kg adjusted body weight divided over 2 to 5 days.

Maintenance (for recurrent or multiphasic ADEM only): 0.4 to 2 g/kg adjusted body weight every 4 to 6 weeks.

Once the patient’s condition has stabilized, consider titrating the dose and/or the treatment interval to the lowest dose necessary to maintain clinical effectiveness.

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For the following indications, there is insufficient or no evidence to support the use of IG. Alternatives to IG are often available.

RecommendationsIG is not recommended

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For the following indications, there is insufficient or no evidence to support the use of IG. Alternatives to IG are often available.

RecommendationsIG is not recommended

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For the following indications, there is insufficient or no evidence to support the use of IG. Alternatives to IG are often available.

RecommendationsIG is not recommended

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For the following indications, there is insufficient or no evidence to support the use of IG. Alternatives to IG are often available.

RecommendationsIG is not recommended

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When screening requests for approval, the following information may be taken into account as there is some evidence for IG to be considered as an option.

RecommendationsNot recommended for routine use.

IVIG may be considered one option among adjunctive therapies, such as steroids, in urgent situations.

Prescribed only in consultation with specialized hemophilia care centre.
Dose/Frequency of AdministrationUp to a total of 2 g/kg divided over 2 to 5 consecutive days, for short term use.

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Includes but not limited to: 

  • Encephalitis associated with antibodies to: NMDA receptor, VGKC, LGI1, CASPR2, DPPX, AMPA receptor, glycine receptor, or GABA (A or B) receptor.
  • Highly suspected autoimmune encephalitis
  • Paraneoplastic encephalitis
  • Seronegative autoimmune encephalitis
  • Seronegative limbic encephalitis
  • Suspected autoimmune limbic encephalitis

(See separate entry for Rasmussen syndrome)

RecommendationsIVIG may be used as an option with expert consultation.
Dose/Frequency of AdministrationInduction: 2 g/kg adjusted body weight divided over 2 to 5 days.

Maintenance: 0.5 to 2 g/kg adjusted body weight monthly, if necessary.

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When screening requests for approval, the following information may be taken into account as there is some evidence for IG to be considered as an option.

RecommendationsIVIG is an option for patients with immunologic pure red cell aplasia (PRCA) who have failed other therapies (e.g., prednisone or cyclosporin). IVIG should be considered first-line therapy for viral PRCA associated with parvovirus B19 in immunocompromised patients.

See separate entry Parvovirus B19 in solid organ transplant recipients.
Dose/Frequency of AdministrationUp to 2 g/kg divided over 2 to 5 consecutive days for short term use.

Repeat on relapse.

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(See separate entry for Demyelinating neuropathy associated with IgM paraproteinemia, without anti-MAG antibodies)

For the following indications, there is insufficient or no evidence to support the use of IG. Alternatives to IG are often available.

RecommendationsRecommendation includes but is not limited to:
  • Axonal neuropathy associated with IgM paraproteinemia.
IG is not recommended.

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