AANEM Publishes New Guidelines for Use of IVIG for Neuromuscular Disorders

In a review of evidence from 2008 to 2021, the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) published a new consensus statement updating its recommendations for the use of intravenous immune globulin (IVIG) for neuromuscular disorders. The updated statement advises against using IVIG for small fiber neuropathy that is idiopathic or related to tri-sulfated heparin disaccharide antibodies or fibroblast growth factor receptor-3, among other evidence-based guidelines. The consensus statement is based on new evidence from clinical trials on the use of IVIG, updating the 2009 AANEM consensus statement. All evidence was categorized as Class I (best evidence) through Class IV (weakest evidence)

Another recommendation that may change clinical practice, said lead study author Jinny Tavee, MD, chief of the division of neurology and behavioral health at National Jewish Health in Denver, is research that strengthens support for the use of IVIG for dermatomyositis. Dr. Tavee pointed to new evidence from the proDERM study showing a significant benefit of IVIG in patients with dermatomyositis compared to placebo, which led to its U.S. Food and Drug Administration approval in 2021. “Clinicians should consider using IVIG as first-line therapy for dermatomyositis,” Dr. Tavee said.

The AANEM panel also recommends clinicians consider following the European recommendations for using IVIG for statin-induced myositis. Although the evidence is insufficient (Class IV) to recommend for or against IVIG to treat necrotizing autoimmune myopathy (often associated with statin-induced myositis), Dr. Tavee said the panel recommended consideration of IVIG as second-line therapy for anti-HMGCR (anti-3-hydroxy-3-methylglutaryl coenzyme A reductase) myopathy given the aggressive nature of the disease and to avoid long-term disability per the 2016 European Neuromuscular Centre consensus statement.