IVIG for Autoimmune Skin Diseases

Dermatomyositis (DM) is a rare inflammatory myopathy with a characteristic skin rash. The rash is violaceous (purple) or dark red and typically appears on the eyelids and over joints such as the knuckles, elbows and knees. It affects both adults and children.

Octagam 10%, an immune globulin intravenous (human), is FDA-approved for adults with dermatomyositis. Other treatments include corticosteroids and immunosuppressive medications.

Pemphigus is a group of rare autoimmune blistering diseases of the skin and mucous membranes, including the mouth, nose, throat and eyes. Autoantibodies target cells in the epidermis, the outer layer of the skin. Pemphigus vulgaris, the most common type, usually begins in the mouth; in pemphigus foliaceus, lesions typically begin on the face and scalp.

Rituxan (rituximab) is FDA-approved for adults with moderate to severe pemphigus vulgaris. Systemic corticosteroids are the mainstay of treatment, often combined with immunosuppressive medications. IVIG is not FDA-approved for pemphigus; physicians may prescribe it off-label.

Pemphigoid is a rare autoimmune blistering disease that causes pruritic (itchy) rashes and blisters, most often on the limbs and abdomen, and occurs most often in older adults. Autoantibodies target the tissue just beneath the epidermis. Its forms include bullous pemphigoid, affecting the limbs and lower abdomen; mucous membrane (cicatricial) pemphigoid, affecting the mouth, eyes and other mucous membranes; and pemphigoid gestationis, which occurs during or shortly after pregnancy.

Treatment usually begins with topical or oral corticosteroids, sometimes with immunosuppressive medications. In severe disease, physicians may prescribe IVIG; this is off-label, as IVIG is not FDA-approved for pemphigoid.

1. The prescriber's office sends a referral: for IVIG, the Immunoglobulin Referral Form (PDF), with recent clinical notes and laboratory results, by fax, or a call.
2. MedRx's intake team verifies insurance benefits and obtains prior authorization when the plan requires it.
3. Medication and supplies are delivered to the patient's door at no charge. Next-day delivery is available; timing varies by location.
4. A skilled, trusted and licensed nurse from an accredited nursing agency administers the infusion, monitors vital signs and adverse reactions, and coordinates with the patient's care team.
5. A MedRx pharmacist is available 24 hours a day, 7 days a week. MedRx's pharmacy team includes Ig Certified Pharmacists (IgCP), who hold a specialty certification in immune globulin therapy.

MedRx dispenses both on-label and off-label prescriptions written by the treating physician. See IVIG at home for more on home IVIG.

Health plans commonly require prior authorization for IVIG and for rituximab. MedRx's intake team verifies coverage and works with the prescriber's office on the documentation before the first delivery. Coverage of off-label use varies by plan.

Where out-of-pocket costs are a barrier, MedRx helps patients find and apply for copay assistance, grants and other financial aid. The manufacturers of Octagam and Rituxan also run patient support programs, named on each medication page.

We fill Octagam and Rituxan.

Each has its own page: what it is approved for, how it is given, and how to start. See every medication we fill.

Read more about home infusion nursing and biologic infusions at home.