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Would IVIG be a smart preventive before travel?

Ask the Doctor Question:

I am a CLL patient (age 77) anticipating international travel. After d/c ibrutinib treatment, three vaccine doses, but no antibody after vaccine. Monoclonals are not available in absence of symptoms or positive test. Would IVIG be a smart preventive before travel?

Answer: You are correct. Technically you would not qualify for Regen-COV at this time under the EUA. We are hoping that this changes very soon for the immunocompromised, but we know that doesn’t help you very much right now.

To answer your specific question about IVIG, it works very similar to convalescent plasma. However, you may have noticed that there isn’t much mention anymore of using convalescent plasma as a form of treatment since the variants have emerged. And convalescent plasma has never been used as a preventative (prophylactically).

Using IVIG for prevention of COVID-19 is completely unproven. The main reason IVIG doesn’t reliably provide protection against COVID-19 is because it is manufactured from thousands of other pooled blood donors. So, there is so much variation in the amount of COVID-19 antibodies that may or may not be present from batch to batch. This makes its effectiveness very unpredictable. There are a few very weak studies which indicate IVIG might keep COVID-19 disease from progressing to severe should you test positive.

That being said, there really is not a downside to receiving it, except for the increased risk of blood clots (although that needs to be taken into consideration since you will be on a plane for a long period of time for international travel). Just know that while receiving IVIG it wouldn’t hurt, the chance of gaining any immunity will still be extremely unpredictable. So, you need to take all of the other precautions you can, such as wearing a tightly fitted N-95 mask while traveling.

Additionally, please make sure you have completed your COVID-19 planning checklists ahead of time and carry these documents with you when you travel. Knowing where you can access anti-SARS-CoV-2 antibodies wherever you go is a cornerstone so you can receive them ASAP after known exposure and/or a positive test result. If you haven’t accessed these checklists already, please visit our website’s CLL Society COVID-19 Plan section.