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).
2 Answers
Mednet MemberInvited Expert
Rheumatology · University of Pittsburgh
Answered on
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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Mednet MemberInvited Expert
Rheumatology · Emory University
Answered on
Of note, in the large phase 3 ProDERM trial of Octagam 20% IVIG for DM led by Dr. @Dr. First Last 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 am...
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