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ASSOCIATION OF BRITISH NEUROLOGIST
GUIDELINES FOR THE USE OF
INTRAVENOUS IMMUNOGLOBULIN IN
1. Scope of guidelines.
These guidelines are the consensus views of an ABN working group (see Appendix 5) on the
use of intravenous immunoglobulin (IVIg) in neurological disorders. They have drawn on
the thoroughly referenced specialist review undertaken by Wiles et al. (2002), which contains
comprehensive level of evidence data. Other useful reviews are given by Dalakas (1999) and
Latov et al. (2001). The guidelines summarise the evidence for clinical effectiveness and give
recommendations for use in each disease category. They evaluate mechanisms, products,
safety and administration regimes, as well as discussing cost effectiveness and patient
concerns. The guidelines are intended to provide advice and support to clinicians and budget
holders involved in treating patients with IVIg. They may complement local guidelines.
IVIg is licensed only for use in Guillain-Barré syndrome (GBS), immunoglobulin deficiency
and Kawasaki disease but is widely used in many other neurological conditions. For some,
there is a sound evidence base but IVIg has been used speculatively in other neurological
diseases with only anecdotal support from the literature. The high cost of IVIg has led to
rationing, and there have also been justified concerns regarding its safety and future
availability. The standard course of IVIg costs approximately £2500 and has become the
major drug expenditure item in many neurology units.
Most neurologists will have confidence and adequate expertise when using IVIg in, for
example, GBS, but for disorders in which IVIg use is considered in the absence of a
supportive systematic review or randomised controlled trial(s), non-specialist neurologists
may consider it wise to seek advice from a colleague with experience in the condition before