Neuromyelitis optica spectrum disorder (NMOSD or NMO) is an autoimmune disease. In autoimmune conditions like NMOSD, a person’s immune system attacks healthy cells and tissue. NMO causes the body to damage cells in the central nervous system, which is made up of your brain, spinal cord, and optic nerve (eyes).1,2
NMOSD can be unpredictable, with periods of more serious symptoms called flares or attacks. Intravenous immunoglobulin (IVIg) is an option for treating or preventing an NMO flare or attack.1,2
IVIg may be an option for people with NMOSD who cannot take intravenous methylprednisolone or have plasmapheresis (also called plasma exchange or PLEX). But IVIg is not used alone as a first choice to treat an NMOSD attack. Evidence supporting the use of IVIg in people with NMOSD is limited, and it is not recommended in current treatment guidelines.1-4
How does IVIg work?
IVIg may be prescribed for people with autoimmune conditions like NMOSD. It is made of antibodies gathered from thousands of healthy donors. IVIg is very similar to normal human plasma.5
IVIg helps support the immune system by building up levels of antibodies needed to fight infection and inflammation. It helps relieve NMOSD symptoms by reducing the body’s attack on the immune system.5
One small study suggested that IVIg provided better results when used in combination with high doses of steroids. In that review, IVIg and steroids used together worked better than either alone.1,4
Another small study found that people who received IVIg and high doses of steroids had a longer time until their next relapse. This was especially true for people with NMO who had AQP4 antibodies. However, both of these studies were limited by very few participants and retrospective nature (using data from the past).1,4
What are the possible side effects?
Side effects from IVIg can happen during the injection or in the days after. The most common side effects during the injection are:5
- Headache
- Fever
- Chills
- Fatigue
Most side effects during injection can be managed with pain relievers or by slowing the transfusion rate, lowering the dose, or using a different type of IVIg. Delayed reactions are rare but tend to be serious. They include infections and kidney, blood, and nerve issues.5
These are not all the possible side effects of IVIg. Talk to your doctor about what to expect when undergoing IVIg. You should also call your doctor if you have any changes that concern you after receiving IVIg.
Other things to know
IVIg is given by IV infusion (into a vein) over 2 to 5 days.2
Some types of IVIg contain additives as well as antibodies. People with certain health conditions may need special forms of IVIg. For example:5
- People with diabetes or kidney disease may need a form of IVIg without added sugar.
- People with heart conditions may need a form of low-salt IVIg.
More studies are needed to better understand when IVIg should be used for NMOSD attacks and the best ways for it to be combined with other treatments such as steroids.2,3
Before beginning treatment for NMOSD, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.