Title:Experimental Investigation of Immunoglobulin and Complement Concentrations
in Exposure to IVIG, HBIG, Rituximab, Tocilizumab, and Bevacizumab
Volume: 20
Issue: 6
Author(s): Murat Caglayan*Ataman Gonel
Affiliation:
- Department of Medical Biochemistry, Health Science University, Diskapi Yildirim Beyazit Training and Research Hospital,
Ankara, Turkey
Keywords:
IVIG, HBIG, IgG, nephelometry, false result, bevacizumab.
Abstract:
Background: Immunoglobulins (Igs) are produced in plasma cells in response to glycoproteinlike
immunogens and they are also used as therapeutics in the pharmaceutical industry. It may be important
to know the effects of therapeutic Igs on Ig levels during therapy to eliminate any misconceptions
about the immunity of patients.
Objective: This study aimed to investigate the effects of monoclonal antibody (mAb) derivative drugs and
therapeutic antibody (intravenous Ig [IVIG] and hepatitis B immune globulin [HBIG]) treatments on
blood IgG, IgA, IgM, IgE, complement component 3 (C3), and complement component 4 (C4) levels.
Methods: N Protein Control SL / Low (Siemens, Marburg, Germany, Lot: 084654) was used as the control
solution. Aliquots of IVIG, HBIG, rituximab, tocilizumab, and bevacizumab (20 μL) were added to
180 μL of the control solution, and the solutions were vortexed (5 s). The samples were studied using a
Dade Behring BN II (Siemens, Marburg, Germany) nephelometer. All measurements were repeated three
times by performing the same process in which distilled water (20 μL) was added to the control solution
to determine the target value, and the average values were taken. The bias formula was used to calculate
the amount by which the results deviated from the target value.
Results: IVIG caused the greatest deviation (45.97%) to IgG levels. HBIG, rituximab, tocilizumab, and
bevacizumab caused the IgG level to deviate by 0.81%, 9.68%, 27.42%, and 30.65%, respectively. In the
IgA test, tocilizumab increased the reading by 8.66%, while the other therapeutics caused reductions in
the reading, with the smallest and largest changes caused by HBIG (-0.93%) and bevacizumab (-4.98%).
Tocilizumab increased the IgE level by 0.48%, and rituximab and bevacizumab reduced the IgE level by -
0.21% with -8.47%, respectively. Tocilizumab, IVIG, and HBIG caused 1.41%, 2.70%, and 4.32% deviations,
respectively, in the C3 levels. Whereas bevacizumab (-1.08%) and rituximab (-5.41%) caused reductions
in the C3 levels. Tocilizumab, HBIG, rituximab, IVIG, and bevacizumab caused deviations of
0.87%, -2.31%, -3.76%, -6.36%, -8.38%, respectively, in the C4 levels.
Conclusion: Deviations in measured IgG levels after therapeutic Ig and mAb infusions may cause errors
in clinical decisions. It is recommended that Ig levels be measured before infusion or when the therapeutic
drug has been eliminated from the blood.
