Takeaways: frequent infusions of immunoglobulin may be more effective than larger, less frequent treatments; there is an insufficiency of data for doctors to use when prescribing treatment plans.
As of this posting, the full free text is available. It's not very long.
Prolonged intravenous immunoglobulin (IVIG) therapy is used for the chronic autoimmune neuropathies chronic idiopathic demyelinating polyneuropathy and multifocal motor neuropathy, but the doses and treatment intervals are usually chosen empirically due to a paucity of data from dose–response studies. Recent studies of the electrophysiology and immunology of these diseases suggest that antibody-induced reversible dysfunction of nodes of Ranvier may play a role in conduction block and disability which responds to immunotherapy more rapidly than would be expected for demyelination or axonal damage per se. Clinical reports suggest that in some cases, the effects of each dose of IVIG may be transient, wearing-off before the next dose is due. These observations lead us to hypothesize that that therapeutic IgG acts by competing with pathologic autoantibodies and that individual patients may require different IgG levels for optimal therapeutic effects. Frequent IVIG dosing and weekly subcutaneous IgG have been tried as ways of continuously maintaining high serum IgG levels, resulting in stabilization of neuromuscular function in small case series. Frequent grip strength and disability measurements, performed by the patient at home and reported electronically, can be used to assess the extent and duration of responses to IgG doses. Individualization of IgG treatment regimens may optimize efficacy, minimize disability, and identify nonresponders.
In conclusion, recent studies of the immunology and electrophysiology of CIDP and MMN suggest that much of the morbidity and disability in these conditions is caused by readily reversible functional effects of autoantibodies rather than more slowly repairable structural damage.18,21 These results serve as a foundation for understanding clinical observations of rapid responses and “wear-off” effects with intermittent IVIG bolus therapy. Together, these observations suggest the hypothesis that infused antibodies in IgG actually compete with pathologic autoantibodies. Observations that dosing of IVIG as often as every 7–10 days or the use of SCIG to continuously maintain high steady-state IgG levels may be preferable to the periodic extremely high peaks and low troughs of IVIG boluses given every 4–6 weeks. Giving smaller doses of IVIG more frequently or routine weekly self-administration of SCIG in the home may be associated with fewer, less severe adverse effects and significant cost savings as compared to intermittent high dose IVIG, which requires administration and monitoring by a trained nurse, even if given at home. Additional research is needed to determine how widely applicable frequent dosing of IVIG or SCIG might be, and whether continuous maintenance of optimal strength/minimal disability is associated with better long-term outcomes. This can only be achieved with the use of frequent monitoring of patients' responses and periodic re-assessments of therapeutic efficacy.