With more potential uses for more diseases, IVIG gains enhanced awareness for its multimodal properties.

Recent national news regarding the emergency approval of convalescent plasma, or immunoglobulins, as a treatment approach in COVID 19 is significant as well for recognizing the application of intravenous immunoglobulin (IVIg) in other conditions where the immune system also has been severely compromised.

Relevant to its use in COVID, IVIG does not target the virus, but is used to help calm the overactive immune response seen in the disease by decreasing the instance of multiple cytokines at one time. Cytokines are proteins secreted by certain cells of the immune system that have an effect on other cells. When released, they signal the immune system to function and affect the growth of all blood and other cells that support the body's immune and inflammation responses.

But, when the immune system is over-activated in the presence and in the aftermath of disease, such as COVID, cytokine storms can wreak havoc with our health. Excessive production of pro-inflammatory cytokines can lead to acute respiratory distress syndrome (ARDS) aggravation and widespread tissue damage resulting in multi-organ failure and death. As such, targeting cytokines during the management of COVID-19 patients could improve survival rates and reduce mortality.1

In this May 2020 article, “Octapharma Uses IVIG as Potential Treatment for COVID-19,” Switzerland-based Octapharma teamed with the University of California at San Diego’s George Sakoulas, an associate professor in the Department of Pediatrics of the UCSD School of Medicine, to assess the potential impact of IVIG in these patients in a blinded Phase III study. While this approach to treating COVID-19 is different than the use of convalescent plasma, the company noted it is working with several partners in that space as well.

These recent developments are especially interesting to us; just a few months ago we had written about questions we’d received from patients regarding IVIG treatments for their previously diagnosed neuroimmune conditions. As we’d noted then, IVIG is both safe and effective and there was no reason to discontinue treatment. And clearly, we are now seeing the multifaceted nature of IVIG and its range of possibilities in treating many different diseases including pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

Dr. Sakoulas compared using IVIG against COVID-19 as fighting an arsonist who has started a wildfire, stating “Everyone keeps going after the virus with an antiviral. That is like trying to catch the arsonist in order to put out the fire. This (IVIG) is dampening the ground in order to fight that fire.”

IVIG has a multimodal mechanism of action and the reason it can be helpful for COVID 19 is the very same reason it’s helpful for ANY autoimmune disease. The mechanisms in all autoimmune and neurodegenerative disease, and for which IVIG use is compelling, includes a post infectious autoimmunity (e.g. molecular mimicry), cytokine dysregulation, possible viral or other pathogen invasion into the central nervous system, and/or peripheral immune dysregulation. You can read more about these mechanisms in an earlier blog too at: https://www.suzannegazdamd.com/blog/ivig-in-autoimmune-disease-therapies.

IVIG to treat the “tsunami upon the tsunami.”

Many of my colleagues and I believe that after this worldwide COVID 19 pandemic, we potentially are going to see a virtual “tsunami” of, or tremendous rise in, post-infectious neuropsychiatric presentations. It’s critical to note too that even before COVID we know that 60% of adults and 30% of children were living with a chronic disease. The impacts of this global virus combined with the social isolation, stress, fear and other issues will likely add to what may be a perfect storm that results in even more health issues for which we must prepare to address.

It’s long past time to support our immune system responses, not only through IVIG as appropriate, but with all the foundations of health and wellness that are inherent to integrative medicine approaches.  

In hope and healing,
Dr. Suzanne Gazda

References and additional reading:

1 Ragab Dina, Salah Eldin Haitham, Taeimah Mohamed, Khattab Rasha, Salem Ramy. The COVID-19 Cytokine Storm; What We Know So Far. Frontiers in Immunology. (2020) Vol. 11, p. 1446.
https://www.frontiersin.org/article/10.3389/fimmu.2020.01446.
doi 10.3389/fimmu.2020.01446. ISSN 1664-3224   

Tamburello Adriana, Marando Marco. Immunoglobulins or convalescent plasma to tackle COVID-19: buying time to save lives – current situation and perspectives. Swiss Med Wkly. 2020;150:w20264. https://doi.org/10.4414/smw.2020.20264

For information regarding an upcoming 2021 clinical trial of IVIG in PANS and PANDAS see:
https://clinicaltrials.gov/ct2/show/NCT04508530?cond=NCT04508530&draw=2&rank=1