Off-Label Use of Intravenous Immunoglobulin (IVIG)
Off-label IVIG for Neurological Conditions:
Studies suggest that IVIG treatment for neurological conditions is promising, but compelling evidence that IVIG works to improve most neurological conditions is lacking.
Evidence suggests that IVIG may be better than plasma exchange for the treatment of pediatric Guillain-Barré Syndrome, and IVIG is shown to be more effective than placebo for the treatment of multiple sclerosis in adults.
IVIG is no better than placebo for Alzheimer disease, encephalitis, or post-polio syndrome.
The results for epilepsy, myasthenia gravis, and chronic inflammatory demyelinating polyneuropathy are mixed, making it unclear whether or not IVIG is an effective treatment.
Off-label IVIG for Hematological Conditions:
No evidence was found for aplastic anemia, autoimmune neutropenia, hyperhemolysis after transfusion, and acquired hemophilia.
A limited amount of evidence was found for blood conditions affecting a fetus or newborn. Overall, the evidence on IVIG for these specific conditions compared with other treatment options was mixed.
Off-label IVIG for Autoimmune or Inflammatory Conditions:
Evidence indicates that the off-label use of IVIG may be effective in some autoimmune diseases but not in others.
IVIG improves outcomes for patients with systemic lupus erythematosus, and it improves cardiac outcomes in infants of mothers with antiphospholipid syndrome during pregnancy.
Limited evidence does not show a benefit with IVIG for dermatomyositis, myasthenia gravis, polymyositis, Kawasaki disease, Sydenham chorea, or cardiac complications of acute rheumatic fever.
Off-label IVIG for Non-neurological Paraneoplastic Disorders:
No evidence was found, so it is not known whether or not IVIG is effective in treating non-neurological paraneoplastic disorders.
Off-label IVIG for Dermatological Conditions:
Evidence is scarce and based mainly on non-randomized studies or small randomized controlled studies.
For Stevens-Johnson syndrome or toxic epidermal necrolysis, IVIG treatment — alone or combined with corticosteroids — did not show survival benefit, but there may be a positive correlation between high-dose IVIG and some clinical benefits.
For bullous pemphigoid, IVIG reduces the time-to-treatment reduction compared with placebo.
For polymyositis or dermatomyositis, IVIG with corticosteroids improves muscle strength and the biochemical profile compared with placebo or corticosteroids alone (IVIG alone compared with placebo does not).
Off-label IVIG for Recurrent Spontaneous Abortion:
Whether IVIG improves the chances of live birth in women who have experienced repeated miscarriage is unclear.
Some studies show no difference in live birth rates with IVIG compared with placebo and other treatments.
Other studies show a significant improvement in rates of live birth with IVIG compared with no IVIG.
Studies that included obstetrical, perinatal, and neonatal outcomes found no important differences between groups treated with IVIG and those not treated with IVIG.
Off-label IVIG for Solid Organ Transplant Rejection:
Limited evidence shows no difference in renal effect with IVIG and rituximab compared with placebo in patients with chronic, antibody-mediated rejection following renal transplant.
Limited evidence shows an improvement in renal function in patients with chronic, antibody-mediated rejection following renal transplant with IVIG versus methylprednisolone.