Clinical Use and Adverse Reactions of Intravenous Immunoglobulin in Filipino Patients in a Tertiary Hospital in Baguio City, Philippines

Abstract

Background: Intravenous immunoglobulin (IVIG) is a pooled antibody and biological agent used to manage various diseases, including autoimmune, infectious, and inflammatory conditions. Its use has increased globally due to the rising number of acute and chronic medical disorders that may benefit from IVIG therapy. IVIG is generally considered safe, with adverse reactions occurring in 10–30% of patients; most are mild and transient.

Methodology: This descriptive study included adult patients who received IVIG from October 1, 2014, to October 31, 2024. Frequencies and percentages were used to describe the clinicodemographic profile of patients, indications for IVIG infusion, observed adverse reactions, and clinical outcomes.

Results and Discussion: A total of 131 patients (51 males, 80 females) received IVIG infusions. Twenty-eight percent (n = 37) experienced adverse reactions. The most common indication was Guillain-Barré Syndrome / Acute Inflammatory Demyelinating Polyneuropathy (AIDP) (29.7%), followed by Myasthenia Gravis (25%) and Autoimmune Encephalitis (25%) among autoimmune diseases. For non-autoimmune diseases, the leading indications were COVID-19 (4.5%) and septic shock (1.5%).

Difficulty of breathing was the most common adverse reaction (n = 14, 10.7%), followed by fever (n = 10, 7.6%) and chest pain (n = 3, 2.2%). Other reported adverse reactions included headache (n = 2, 1.5%), lightheadedness (n = 1, 0.7%), tachycardia (n = 1, 0.7%), abdominal pain (n = 1, 0.7%), nausea (n = 1, 0.7%), vomiting (n = 1, 0.7%), diarrhea (n = 1, 0.7%), epistaxis (n = 1, 0.7%), and cardiac arrest (n = 1, 0.7%). Most patients were discharged improved (n = 102, 77.9%); 5.3% were discharged against medical advice, and 22 patients (16.8%) died.

Conclusion: Among autoimmune diseases, the most common indications for IVIG use were Guillain-Barré Syndrome / Acute Inflammatory Demyelinating Polyneuropathy (AIDP), Myasthenia Gravis, Autoimmune Encephalitis, Systemic Lupus Erythematosus (SLE), and Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). For non-autoimmune diseases, COVID-19 and septic shock were the leading indications. The most frequent adverse reaction was difficulty of breathing, followed by fever, chest pain, and headache. The most severe adverse event was cardiac arrest. Less common adverse reactions included lightheadedness, tachycardia, abdominal pain, nausea, vomiting, diarrhea, and epistaxis.