474. Relative EBV concentrations and cost of standard IVIG and CMV-IVIG for PTLD prophylaxis in solid organ transplant patients
Session: Poster Abstract Session: Prevention and Treatment of Viral Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • EBV Antibody IVIG CMVIVIG 9.27.13.pdf (125.8 kB)
  • Background: CMV-IVIG is approved for the primary prophylaxis of CMV for solid organ transplant patients who are serodiscordant with their donor.  In addition to reducing immunosuppression, some centers prefer CMV-IVIG over intravenous immunoglobulin (IVIG) for the prophylaxis of EBV-related PTLD in solid organ transplant patients.  Our objective was to compare the relative dose-related EBV ELISA antibody concentrations and cost of CMV-IVIG and standard IVIG.   

    Methods: The concentration of EBV IgG to viral capsid antigen were analyzed via enzyme-linked immunosorbent assay (ELISA) in four lots of IVIG (Privigen, CSL Behring) and three vials encompassing two lots of CMV-IVIG (Cytogam, CSL Behring).  The concentration of CMV antibodies in the two products were also measured via ELISA.  Two fold dilutions of all samples were carried out and all lots were run at least in duplicate.  The final concentration was determined as the geometric mean between the highest positive and clear negative ELISA value.  Relative EBV ELISA antibody concentrations and cost were compared assuming an IVIG dose of 500 mg/kg and CMV-IVIG dose of 150 mg/kg in a 50kg patient.  The price of IVIG was $70/gram and CMV-IVIG $430/gram.  Relative CMV ELISA antibody concentrations were also compared. 

    Results: Standard IVIG contains higher EBV antibody concentrations determined by ELISA (20,790 ELISA antibody units/mL) than CMV-IVIG (16,800 ELISA antibody units/mL).  Assuming a 50kg patient, standard IVIG contains 2 times more EBV antibody than CMV-IVIG.  Yet, CMV-IVIG is 1.8 times more expensive than IVIG ($3225 vs. $1750).  CMV-IVIG contains 3.5 times the CMV antibody concentration determined by ELISA than standard IVIG (67,620 ELISA antibody units/mL vs. 19,110 ELISA antibody units/mL).  An 1,100 mg/kg dose of standard IVIG contains the same amount of CMV ELISA antibody units compared to 150 mg/kg CMV-IVIG. 

    Conclusion: Although CMV-IVIG is preferred for EBV-related PTLD prophylaxis in solid organ transplant patients at some centers, standard IVIG contains more EBV antibodies and costs less when factoring in the dosing scheme.  More studies are needed to determine if there is clinical efficacy of immunoglobulins, the relative clinical efficacy of the two immunoglobulin products, and the most appropriate dosing regimen for EBV-related PTLD prophylaxis.

    Lynn Ramirez-Avila, MD, MSc1, Omai Garner, PhD2 and James D. Cherry, MD1, (1)Division of Pediatric Infectious Diseases, UCLA School of Medicine, Los Angeles, CA, (2)Department of Microbiology, UCLA School of Medicine, Los Angeles, CA


    L. Ramirez-Avila, None

    O. Garner, None

    J. D. Cherry, None

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