DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

Table 35–2
Selected Immune Globulin Preparations
GENERIC NAME COMMON SYNONYMS ORIGIN BRAND NAME
Antithymocyte globulin ATG Rabbit THYMOGLOBULIN
Botulism immune globulin intravenous BIG-IV Human BABYBIG
Cytomegalovirus immune globulin intravenous CMV-IGIV Human CYTOGAM
Hepatitis B immune globulin HBIG Human HEPAGAM B, HYPERHEP B S/D, NABI-HB
Immune globulin intramuscular Gamma globulin, Human GAMASTAN S/D
IgG, IGIM
Immune globulin intravenous IVIG Human CARIMUNE NF, FLEBOGAMMA 5%,
GAMMAGARD LIQUID, GAMUNEX,
IVEEGAM EN, OCTAGAM, PRIVIGEN
Immune globulin subcutaneous IGSC Human VIVAGLOBIN
Lymphocyte immune globulin ALG, antithymocyte Equine ATGAM
globulin (equine),
ATG (equine)
Rabies immune globulin RIG Human HYPERRAB S/D, IMOGAM RABIES–HT
Rho(D) immune globulin intramuscular Rho[D] IGIM Human HYPERRHO S/D, RHOGAM
Rho(D) immune globulin intravenous Rho[D] IGIV Human RHOPHYLAC, WINRHO SDF
Rho(D) immune globulin microdose Rho[D] IG microdose Human HYPERRHO S/D MICRODOSE,
MICRHOGAM
Tetanus immune globulin TIG Human BAYTET
Vaccinia immune globulin intravenous VIGIV Human Generic
Specific immune globulin preparations are available for hepatitis
B, rabies, tetanus, varicella-zoster, cytomegalovirus, botulism,
and respiratory syncytial virus. Rho(D) immune globulin is a specific
hyperimmune globulin for prophylaxis against hemolytic disease of
the newborn due to Rh incompatibility between mother and fetus. All
such plasma-derived products carry the theoretical risk of transmission
of infectious disease.
Rho(D) Immune Globulin. The commercial forms of Rho(D)
immune globulin (Table 35–2) consist of IgG containing a high titer
of antibodies against the Rh(D) antigen on the surface of red blood
cells. All donors are carefully screened to reduce the risk of transmitting
infectious diseases. Fractionation of the plasma is performed by
precipitation with cold alcohol followed by passage through a viral
clearance system (Bowman, 1998).
Mechanism of Action. Rho(D) immune globulin binds Rho antigens,
thereby preventing sensitization (Peterec, 1995). Rh-negative women
may be sensitized to the “foreign” Rh antigen on red blood cells via
the fetus at the time of birth, miscarriage, ectopic pregnancy, or any
transplacental hemorrhage. If the women go on to have a primary
immune response, they will make antibodies to Rh antigen that can
cross the placenta and damage subsequent fetuses by lysing red
blood cells. This syndrome, called hemolytic disease of the newborn,
is life-threatening. The form due to Rh incompatibility is
largely preventable by Rho(D) immune globulin.
Therapeutic Use. Rho(D) immune globulin is indicated whenever
fetal red blood cells are known or suspected to have entered the circulation
of an Rh-negative mother unless the fetus is known to also
be Rh negative. The drug is given intramuscularly. The t 1/2
of circulating
immunoglobulin is ~21-29 days.
Toxicity. Injection-site discomfort and low-grade fever have been
reported. Systemic reactions are extremely rare, but myalgia,
lethargy, and anaphylactic shock have been reported. As with all
plasma-derived products, there is a theoretical risk of transmission
of infectious diseases.
Intravenous Immunoglobulin (IVIG). In recent years,
indications for the use of IVIG have expanded beyond
replacement therapy for agammaglobulinemia and
other immunodeficiencies to include a variety of bacterial
and viral infections, and an array of auto-immune
and inflammatory diseases as diverse as thrombocytopenic
purpura, Kawasaki disease, and auto-immune
skin, neuromuscular, and neurological diseases.
Although the mechanism of action of IVIG in immune modulation
remains largely unknown, proposed mechanisms include
modulation of expression and function of Fc receptors on leukocytes
and endothelial cells, interference with complement activation and
cytokine production, provision of anti-idiotypic antibodies (Jerne’s
network theory), and effects on the activation and effector function
of T and B lymphocytes. Although IVIG is effective in many autoimmune
diseases, its spectrum of efficacy and appropriate dosing
(especially duration of therapy) are unknown. Additional controlled
studies of IVIG are needed to identify proper dosing, cost-benefit,
and quality-of-life parameters.