Intravenous Immunoglobulin As Adjunctive Therapy in Relapsing Remitting Multiple Sclerosis: A Novel Approach to Improving Quality of Life and Reducing Fatigue

Background: Relapsing remitting multiple sclerosis is an autoimmune neurological condition, characterized by intermittent attacks of central nervous system demyelination. Research has led to advances in the preventive management of relapses, but there is not a therapy aimed at improving quality of life; which includes severe fatigue, cognitive issues, and gait disturbance frequently encountered by those living with multiple sclerosis.

As a referral center for MS, our practice treats patients who have progressed despite receiving standard disease modifying therapies (DMT). When a patient on a DMT reports persistent breakthrough symptoms and/or shows progression in disability or new MRI findings, our approach is to consider a change in DMT. In the subset of patients in whom a change in DMT is not enough to control their disease activity and MS symptoms, we consider the addition of intravenous immunoglobulin (IVIG) to their DMT.

Studies of IVIG monotherapy have shown inconsistent results, and it has been our experience that IVIG monotherapy is insufficient to control disease activity. However, when used in conjunction with traditional DMTs as complementary therapy, we noted a marked improvement in patient-reported quality of life.

Objectives: To describe the effects of IVIG when used as an adjunctive therapy alongside standard DMTs to increase energy, decrease fatigue, and improve cognition and overall quality of life.

Methods: A retrospective review of all charts at HonorHealth Neurology of patients who have received IVIG in addition to their standard DMT will be conducted. Patient reported outcomes including whether or not they have seen an improvement or worsening in: energy levels, cognition, relapse frequency, gait, and overall disease activity, will be analyzed.

Results: Early data suggests that there is a significant improvement in fatigue, energy, cognition and other key aspects of multiple sclerosis quality of life with the addition of adjunctive IVIG. We are hopeful that this data, as assessed by patient reported outcomes, will show improvements across several domains of quality of life. 

Conclusions: A clear unmet need in relapsing MS is a therapy that can be used in a complementary manner with standard DMTs to reduce fatigue and increase quality of life in MS patients. Pulse adjunctive IVIG may demonstrate the ability to meet this need.

Conclusive results and data will be available and provided by the time of the meeting in May.