Intravenous immunoglobulins (IVIg) are increasingly being used in the treatment of idiopathic inflammatory myopathies (IIM) - particularly in complex or treatment-resistant cases. In a large international study led by the Clinical Department of Rheumatology at the Medical University of Vienna, a comprehensive overview of the real-world use of IVIg in clinical practice worldwide has now been compiled for the first time. The results, published in EULAR Rheumatology Open, reveal significant differences in the use of IVIg between countries, specialisms and healthcare systems, and highlight existing gaps between clinical practice and evidence.
The study was conducted under the leadership of Kastriot Kastrati, Helga Lechner-Radner (both from the Clinical Department of Rheumatology, University Clinic for Internal Medicine III, MedUni Vienna) and Hectory Chinoy (The University of Manchester, UK) as part of the international MyoNet network. A total of 68 centres from 27 countries provided data on their treatment strategies. "Our aim was to gain a realistic picture of how IVIg is actually used in everyday clinical practice," explains lead author Kastriot Kastrati, outlining the starting point. "It became apparent that treatment decisions are influenced not only by clinical factors, but also strongly by local conditions and availability." - "The results underscore the urgent need for harmonised, evidence-based recommendations," adds Helga Lechner-Radner. "At the same time, it is clear that access to innovative therapies such as IVIg is unevenly distributed worldwide - a key issue for future care."
Idiopathic inflammatory myopathies are a heterogeneous group of autoimmune diseases involving the muscles and organs. Intravenous immunoglobulins are antibodies administered directly into a vein via an infusion to support the immune system or counteract dysregulation. Whilst corticosteroids and conventional immunosuppressants remain the standard of care, IVIg is increasingly being used in cases of treatment-resistant disease, rapidly progressive courses and/or severe manifestations such as dysphagia. According to the current study, IVIg was most frequently used in dermatomyositis (85.3%) and immune-mediated necrotising myopathy (82.4%).
Global differences
The study also shows that IVIg is rarely used as first-line therapy, but plays a central role as secondor third-line therapy. It is frequently used in combination with other immunosuppressive therapies. Of particular relevance is the fact that IVIg is frequently used in clinical situations for which there is only limited evidence, including dysphagia, interstitial lung disease and cardiac or gastrointestinal manifestations. This highlights the need for further research. A key finding of the analysis is the significant influence of socio-economic factors on access to IVIg. Centres in lower-income countries reported constraints due to cost and availability significantly more frequently. This makes it clear that treatment decisions are shaped not only by medical considerations but also by structural factors.
The study provides the first global overview of the real-world use of IVIg in myositis and identifies key areas for future research. The findings support the development of internationally coordinated treatment strategies that take into account both scientific evidence and real-world healthcare conditions.
Publication: EULAR Rheumatology Open
International IVIg prescription patterns in idiopathic inflammatory myopathies: real-world insights from the MyoNet survey.
Kastriot Kastrati et al.
DOI: 10.1016/j.ero.2026.02.012
https://www.sciencedirect.com/science/article/pii/S3050708126000297?via%3Dihub
