Safety and effectiveness of concurrent intravenous immunoglobulin and biologics

Summary: This study analyzes treatment discontinuation rates and adverse events in patients receiving concurrent intravenous immunoglobulin (IVIG) and biologics to evaluate the real-world impact of IVIG on biologic effectiveness, as prior studies showed IVIG accelerates clearance of monoclonal antibodies and thus potentially reduce effectiveness of biologics. A retrospective analysis was conducted to identify patients who received both IVIG and biologic treatments for at least 4 overlapping weeks between 2000 and 2024 at Mayo Clinic locations in Minnesota, Arizona, and Florida; patients with autoimmune or autoinflammatory disorders received IVIG and biologics as complementary therapies for the same condition or as distinct treatments for coexisting autoimmune conditions. 19 patients met the inclusion criteria and were treated with concurrent IVIG and biologics: dupilumab (7), ustekinumab (5), infliximab (4), adalimumab (2), and etanercept (1). 7 were treated with high-dose IVIG (2g/kg every 4 weeks). 4 patients received biologics and IVIG for the same indications: pyoderma gangrenosum (2), polyarteritis nodosa (1), and bullous pemphigoid (1). 15 (79%) patients remained on IVIG and biologics for at least 3 months, with a median concurrent treatment duration of 313 days. 17 (89%) patients experienced response with biologic. Biologics were discontinued due to complete remission (3), side effects (2), and treatment ineffectiveness (1). Adverse events related to IVIG included hypertension (1), itching (1), and headaches (1). No thromboembolic events occurred. Side effects in patients receiving biologics included bruising, fatigue, and flaring of CIDP (1; ustekinumab) and diarrhea and transaminitis (1; ustekinumab). Our findings support the safety and effectiveness of concurrent IVIG and biologics, without evidence of significant adverse events, though further studies with larger sample sizes are needed to further evaluate this combined therapeutic approach. Cathleen Huang¹, Stella Chen², Alex Wonnaparhown³ 1. Mayo Clinic Alix School of Medicine, Scottsdale, AZ, United States. 2. Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, United States. 3. Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic Arizona, Phoenix, AZ, United States. Clinical Research: Epidemiology and Observational Research