- What is the clinical effectiveness of the off-label use of intravenous or subcutaneous immunoglobulin for the treatment of autoimmune or inflammatory conditions?
Off-Label use of IVIG may be effective in some autoimmune disease but not in others. For instance women who were treated for antiphospholipid syndrome during pregnancy with combination of IVIG with plasma exchange and steroids had children with significantly less cardiac complication than those who received steroids alone. Also, patients with systemic lupus erythematosus had significant reduction is disease activity and improvement in symptoms from baseline following treatment with IVIG. However, there was insufficient evidence that IVIG was effective for the treatment bullous pemphigoid carditis of acute rheumatic fever, dermatomyositis, myasthenia gravis, polymyositis, Kawasaki disease, and Sydenhams chorea. Each of the autoimmune conditions was investigated by one study, except for dermatomyositis and myasthenia gravis which were investigated by two and three studies, respectively. Overall, considering the limitations in the study designs, reporting of outcomes, limited sample sizes, and risk of bias, there is limited evidence to suggest that off-label IVIG is clinically effective for the treatment of autoimmune diseases.