Why is IV Ig rarely prescribed as a DMT in MS ? It seems to be the only treatment that keeps my child stable.
I guess the straight answer is that the clinical trials of IV Ig in different forms of MS have provided variable results. One of the more recent studies, best categorized as a phase II dose finding study, found no benefit for either dose tested on either clinical or MRI outcomes. I could review all the trial results over the past 20 years but it is easier to just sum these results:
1. IV Ig may have a benefit on delaying a second attack of MS after the onset of the disease
2. IV Ig is probably not a useful treatment of acute MS relapses
3. IV Ig may marginally reduce relapse rates
4. IV Ig probably doesn’t have a significant effect on disease progression later in the course of the disease
5. IV Ig may be particularly useful post partum to prevent relapses in the first 3-6 months after giving birth, although further studies are needed
Most importantly, we simply do not know who benefits from IV Ig. Many of us believe we have patients who benefit from this treatment, but we have no way of determining this prior to treatment and there seem to be more highly effective alternative treatments.
Revere (Rip) Kinkel MD
Director of the UCSD Multiple Sclerosis Center