Effective dosing strategies for therapeutic immunoglobulin: managing wear-off effects in antibody replacement to immunomodulation.

Abstract

Determining optimal dosing strategies for therapeutic immunoglobulin (Ig) to minimize ‘wear-off’ effects (defined here as end-of-cycle loss of efficacy, although wear-off may also refer to secondary end-points such as fatigue) is particularly challenging in the face of limited data. Loss of efficacy of Ig therapy is linked to waning bioavailability and may be explained on the basis of Ig pharmacokinetics and catabolism. It is predominantly a problem with intravenous immunoglobulin (IVIg) as replacement therapy or as an immunomodulator. However, there are no systematic data on the scale of the problem.