title: Relative EBV antibody concentrations and cost of standard IVIG and CMV-IVIG for PTLD prophylaxis in solid organ transplant patients.
abstract: Some centers prefer CMV-IVIG over 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 standard IVIG and CMV-IVIG. The concentration of EBV IgG to VCA was analyzed via ELISA in four lots of IVIG and four lots of CMV-IVIG. Relative EBV ELISA antibody concentrations and cost were compared assuming an IVIG dose of 0.5 gm/kg and CMV-IVIG dose of 0.15 gm/kg in a 50-kg patient. The price of IVIG was $70/gm and CMV-IVIG $430/gm. IVIG contains the same EBV antibody concentrations (20 790 ELISA antibody units/mL) than CMV-IVIG (17 430 ELISA antibody units/mL, p > 0.2) in the four lots of each product sampled. When factoring in the dosing scheme for a 50-kg patient, IVIG contains two times more EBV antibody than CMV-IVIG. Yet, CMV-IVIG is 1.8 times more expensive than IVIG ($3225 vs. $1750). In the four lots of each product sampled, IVIG contains more EBV antibodies and costs less than CMV-IVIG when factoring in the dosing scheme. Studies are needed to determine whether there is clinical efficacy of immunoglobulin products for EBV-related PTLD prophylaxis.
authors.affiliation: Mattel Children's Hospital, David Geffen School of Medicine, UCLA, University of California, Los Angeles, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Ramirez-Avila
authors.forename: O B
authors.initials: OB
authors.lastname: Garner
authors.forename: J D
authors.initials: JD
authors.lastname: Cherry
mesh_terms: D000914:Antibodies, Viral / Q000276:immunology; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000517:prevention & control*; D004797:Enzyme-Linked Immunosorbent Assay; D020031:Epstein-Barr Virus Infections / Q000276:immunology / Q000517:prevention & control*; D004854:Herpesvirus 4, Human / Q000187:drug effects* / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics* / Q000276:immunology / Q000494:pharmacology*; D008232:Lymphoproliferative Disorders / Q000276:immunology / Q000517:prevention & control*; D016377:Organ Transplantation
chemical_list: D000914:Antibodies, Viral; D016756:Immunoglobulins, Intravenous
keywords: Epstein-Barr virus; cytomegalovirus-intravenous immunoglobulin; intravenous immunoglobulin; post-transplant lymphoproliferative disorder