Abstract Details

Title Factors associated with headache in intravenous immunoglobulin treatment for neurological diseases.

Topic Autoimmune Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-071

Objective To identify possible factors influencing the incidence of intravenous immunoglobulin (IVIg) treatment-related cephalgia in neurological diseases.

Background In IVIg treatment, headache and vital sign changes are common and transient side effects. The general safety profile of IVIg therapy is well established and headache management has been reviewed. However, the possible underlying mechanisms and patterns of these side effects are not fully clarified yet.

Design/Methods Retrospective chart review of neurological patients receiving IVIg treatment between July 13th and August 14th 2017. MS patients receiving natalizumab were analyzed as controls as both natalizumab and IVIg are nondepleting infusion therapies. Vital signs were measured before and after infusion.

Results Patients with headache after IVIg infusion (n=22 infusions) showed a reduced heart rate (by 6.0 ± 8.5 beats per minute (bpm), mean ± SD), but no significant difference in blood pressure (RR). Patients without headache after IVIg infusion (n=69 infusions) showed a higher systolic RR and a stronger reduction of the heart rate (by 5.7 ± 8.6 bpm), compared to patients with headache after IVIg infusion. The infusion rate was significantly slower in patients developing headache after IVIg infusion. Body temperature was unchanged in both groups. Binary logistic regression analysis revealed that RR at baseline and age significantly influence the occurrence of cephalgia. In the MS control cohort receiving natalizumab, systolic RR dropped and heart rate decreased, while body temperature increased. Here, one patient with headache was observed.

Conclusions IVIg-associated headache is not associated with an increased RR after infusion, but with a reduced heart rate, a slower infusion rate, female gender and seems to be influenced by baseline systolic RR and age. A reaction to immunoglobulin aggregates, stabilizers or vasoactive mediators are possible explanations. The absence of an association with body temperature does not suggest a systemic immune response as a cause for headache.

Authors/Disclosures
Jonas Graf PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Philipp Albrecht, PhD (Neurologische Universitatsklinik Dusseldorf)	Dr. Albrecht has received personal compensation for serving as an employee of Abbvie. Dr. Albrecht has received personal compensation for serving as an employee of Biogen. Dr. Albrecht has received personal compensation for serving as an employee of Bristol Myers Squibb. Dr. Albrecht has received personal compensation for serving as an employee of Ipsen. Dr. Albrecht has received personal compensation for serving as an employee of Merck. Dr. Albrecht has received personal compensation for serving as an employee of Merz. Dr. Albrecht has received personal compensation for serving as an employee of Novartis. Dr. Albrecht has received personal compensation for serving as an employee of Roche. Dr. Albrecht has received personal compensation for serving as an employee of Sanofi. Dr. Albrecht has received personal compensation for serving as an employee of Lilly.
Hans-Peter Hartung, MD, FAAN (Heinrich Heine University Medical Faculty)	Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS Celgene. Dr. Hartung has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Geneuro. Dr. Hartung has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Hartung has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers Neurology.
Marius Ringelstein	Marius Ringelstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Marius Ringelstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion.
Orhan Aktas, MD (Neurologische Klinik)	Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen/Horizon. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubish Tanake. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AstraZeneca. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen/Horizon. The institution of Dr. Aktas has received research support from German Research Foundation. The institution of Dr. Aktas has received research support from German Ministry of Science. The institution of Dr. Aktas has received research support from Neuromyelitis optica Study Group (NEMOS).

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