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Rheumatology • Myositis
Do you recommend discontinuing IVIG for a newly diagnosed HMGCR+ statin induced necrotizing myopathy who developed a recent brachial DVT?
The patient was diagnosed with statin-induced necrotizing myopathy (HMGCR +) and received RTX and IVIG (one cycle over 3 days) but developed brachial vein thrombosis (unclear if she had a PICC line and this a provoked DVT or not). She's due for her next IVIG cycle in a couple of days. Clinically making good progress. CK hovered around 3000s for a week (downtrended from initial 24K level).
Answer from: at Academic Institution
Really, the issue is if the DVT was provoked or not. If possibly not provoked then would decrease the dose of IVIG or give it over a long time frame. For example, if the patient is on 2 gm/kg over 2 days, I would do 2 gm/kg over 4 days. Or reduce the dose to 1 gm/kg over 2 days.
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Answer from: at Academic Institution
Of note, in the large phase 3 ProDERM trial of Octagam 20% IVIG for DM led by Dr. @Rohit Aggarwal and colleagues, the incidence of IVIG-associated thromboembolic events seemed highly dependent on the infusion rate of the IVIG preparation:
Interim safety analyses during the trial led to a protocol a...