2. IVIg Therapy

3. What are Immunoglobulins?
Immunoglobulins, also known as antibodies, are proteins that bind specifically to antigens
Immunoglobulin products consist of antibodies from large pools of human plasma.
The large plasma pools contain antibodies that are protective against many different pathogens (bacteria, viruses, fungi, etc)
So, let’s take a closer look at the antibodies, also known as immunoglobulins. Immunoglobulins are proteins produced by plasma cells and lymphocytes that bind to antigens. Antigens are toxins or foreign substances that trigger an immune response.
Ig products consist of purified antibodies from large pools of human plasma. This could be over a thousand or more blood donors. The plasma undergoes an extremely rigorous purification process is to remove toxins and contaminants. These include physiochemical fractionation, chromatography (separation by weight), class-specific affinity, and antigen-specific affinity. In addition to the pre-screening donor process that occurs before plasma donation.
What’s left is a super-enriched product that protects against many different pathogens.

4. Where does IG come from? Composition of Blood
Red Blood Cells
White Blood Cells
Platelets
Plasma
Water (92%)
Protein (8%)
Albumin
Immunoglobulin
Blood Clotting Factor
Alpha-1 Proteinase Inhibitors
HAE (Hereditary Angio Edema)

5. IVIG- How is it obtained?
Fractionation Facility to Fractionate or “breakdown” the blood
The process:
Plasma
Obtained from donor
Antibody removal
Chemical treatment
Filtration to remove viruses
Freeze dried
Held for up to 1 year
Cost is approximately $3,000 per child (smaller doses) to $10,000 per adult per dose.

6. Treatments/Myositis Corticosteroids Disease Modifiers IVIG
Most commonly prescribed
Anti-inflammatory: reduce inflammation and swelling
May be given orally or IV
Home infusion therapy is available for IV therapy
Disease Modifiers
Immunosuppressive MOA
May be given orally or IV
Home infusion therapy is available for IV therapy
Anti-inflammatory properties
Highly effective in autoimmune disorders
May be administered SQ or IV
Home infusion therapy is available for both SQ and IV therapy
IVIG
MOA = Mechanism of Action (meaning it works by suppressing the immune system. )

7. IVIG- How is it used in Myositis?
Broadly considered ineffective for Inclusion Body Myositis
Is utilized in Autoimmune diseases such as Dermatomyositis and Polymyositis
Where The body’s immune system attacks muscle tissue
IVIG is effective in autoimmune disorders due to its anti-inflammatory properties
May see a response in hours
Some patients may need to wait months for them to feel better
The sooner a patient receives therapy the greater the chance of a positive response

8. IVIG – How is therapy arranged?
MD and patient decide IG therapy is appropriate
MD sends order and clinical support documentation to Intake Coordinator
Benefits are verified, pharmacist reviews/enters orders, authorization is requested from Insurance company
Authorization is granted
Delivery of medication and coordination of Nursing is scheduled with the patient based what works best for them

9. IVIG – How is IG administered?
Available via Home infusion or Outpatient Infusion Center
Home infusion allows for greater flexibility and the comfort of home as well as availability of many different brands of Ig product.
Patients usually infuse every 3-4 weeks
RN administers therapy and is present for duration of therapy
Autoimmune conditions usually require longer infusion times due to larger doses. Typically 3 to 5 hours per day for 2 to 4 days