This is a new review paper which examines evidence from clinical trials and clinicians who have used immunoglobulin G (IgG) as a treatment for ME/CFS
It has been co-authored by Dr Nigel Speight – honorary paediatric adviser to the MEA
The new NICE guideline reviewed the clinical trial evidence on safety and efficacy for this treatment and did not conclude that it could be recommended by NICE
If you are being treated with intramuscular, subcutaneous or intravenous immunoglobulin G, or have been in the past, please let us have your feedback
The findings of controlled trials on use of intravenous immunoglobulin G (IV IgG) to treat myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are generally viewed as representing mixed results.
On detailed review, a clearer picture emerges, which suggests that the potential therapeutic value of this intervention has been underestimated.
Our analysis is consistent with the propositions that:
(1) IgG is highly effective for a proportion of patients with severe and well-characterised ME/CFS;
(2) responders can be predicted with a high degree of accuracy based on markers of immune dysfunction.
Rigorous steps were taken in the research trials to record adverse events, with transient symptom exacerbation commonly experienced in both intervention and placebo control groups, suggesting that this reflected the impact of participation on people with an illness characterised by post-exertional symptom exacerbation. Worsening of certain specific symptoms, notably headache, did occur more commonly with IgG and may have been concomitant to effective treatment, being associated with clinical improvement.
The findings emerging from this review are supported by clinical observations relating to treatment of patients with severe and very severe ME/CFS, for whom intramuscular and subcutaneous administration provide alternative options.
We conclude that:
(1) there is a strong case for this area of research to be revived;
(2) pending further research, clinicians would be justified in offering a course of IgG to selected ME/CFS patients at the more severe end of the spectrum.
As the majority of trial participants had experienced an acute viral or viral-like onset, we further suggest that IgG treatment may be pertinent to the care of some patients who remain ill following infection with SARS-CoV-2 virus.
Dr Charles Shepherd
Hon Medical Adviser MEA
This paper is also being discussed on the Science 4 ME forum here