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In Reply: The effort of Dr Padua and colleagues to provide data on QOL assessments after administration of IVIG is commendable and the results quite informative. However, I had envisioned a more comprehensive approach that combines QOL with pharmacoeconomics to provide comparable data between IVIG and other equally effective therapies.¹

Intravenous immunoglobulin is a very expensive drug that in some disorders such as CIDP is as effective as prednisone, which is quite inexpensive. Early in the treatment of these disorders, IVIG is more costly than prednisone. However, for patients treated with prednisone alone for more than 2 to 3 years, the irreversible steroid adverse effects (osteoporosis, cataracts, diabetes, hypertension, obesity, avascular necrosis of the hip), seemingly incomplete response, frequent physician visits, time lost from work, and QOL issues may make the true cost comparable with that of IVIG.¹ Preliminary data on CIDP from a double-blind study comparing IVIG to steroids² . . . [Full Text of this Article]

Marinos C. Dalakas, MD
National Institute of Neuromuscular Diseases and Stroke
National Institutes of Health
Bethesda, Md

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Intravenous Immunoglobulin and Quality of Life
Luca Padua, Irene Aprile, Pietro Caliandro, Costanza Pazzaglia, and Pietro Tonali
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