Intravenous immunoglobulin, known as IVIG, and subcutaneous immunoglobulin, known as SCIG, are plasma-derived treatments that are essential for many people living with immune-mediated neuromuscular conditions. Because Canada continues to rely on imported plasma and demand is increasing each year, protecting access to these therapies is critical for patients who depend on them.
For people living with Myasthenia Gravis (MG) and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), IVIG can provide meaningful improvement in strength and daily function. However, international MG guidelines are clear: IVIG should not be used as long-term maintenance therapy for most individuals with stable MG. Chronic IVIG is recommended only for people with refractory disease, meaning those who do not respond to or cannot tolerate other treatments.
For the broader MG population, guidelines encourage the use of steroid sparing therapies and targeted biologics when appropriate. Canada now has five Health Canada–approved targeted biologic therapies for generalized MG, and clinical evidence shows that these therapies can reduce symptoms, improve daily function and serve as appropriate alternatives for selected individuals. Yet access to these therapies remains inconsistent across the country. In several provinces, limited or delayed formulary coverage keeps patients on IVIG longer than intended and prevents clinicians from offering therapies that are already standard practice in comparable health systems.
Through Muscular Dystrophy Canada’s Canadian MG Journey Mapping study, many individuals shared that they often do not know what a meaningful “good enough” response to IVIG should look like, when a change in treatment may be needed or how to engage in shared decision making with their clinicians. This uncertainty can prolong IVIG use even when symptoms remain uncontrolled, or when alternatives may offer better outcomes.
In 2025, Muscular Dystrophy Canada conducted a national policy initiative involving more than eighty experts and a national roundtable at the Canadian Society for Transfusion Medicine Annual Meeting in St. Johns, Newfoundland. Across neurologists, transfusion specialists, economists, Canadian Blood Services and patient partners, a consistent message was clear: Canada must protect IVIG while improving access to the MG therapies that guidelines already recommend. Experts also confirmed that IVIG supply is currently stable, supported by national and provincial shortage management plans, and that Canadian Blood Services continues its long-term work to increase plasma self-sufficiency. They emphasized that this stability can be maintained if Canada makes better use of new MG therapies and ensures they are available and accessible. Even modest shifts toward appropriate alternatives were viewed as meaningful steps that strengthen sustainability and improve patient care.
Muscular Dystrophy Canada is now advocating for solutions that reflect this evidence. This includes supporting accelerated and harmonized access to targeted MG therapies, strengthening IVIG stewardship, and ensuring that patient experience guides policy decisions. MG also serves as an important case study for how thoughtful use of alternatives can benefit the broader neuromuscular and rare disease community.
Key Learnings
- As demand rises, we must ensure uninterrupted access for people with MG, CIDP, inflammatory myopathies, and others who rely on IVIG as a therapy.
- When Health Canada–approved therapies are not covered on provincial formularies, patients cannot benefit from treatments that may reduce symptoms, improve quality of life or decrease reliance on IVIG.
- Patients need clear information about what to expect from IVIG, when it may no longer be effective, and what options exist. This is essential for treatment satisfaction and safety.
- Appropriate use of alternatives reduces unnecessary IVIG use and supports long-term plasma sustainability for all conditions that rely on it.
- Canada must continue investing in domestic plasma collection, stewardship and access to innovation to ensure long-term security of supply.
Muscular Dystrophy Canada calls on policymakers, clinicians, donors and partners to modernize neuromuscular care in Canada. Until cures are found, people with neuromuscular disorders must have equitable access to the full range of effective treatments, from essential therapies like IVIG to the new targeted options that are transforming care. Access should not depend on where someone lives or on restrictive criteria. Every Canadian with a neuromuscular disorder deserves timely, evidence-based care that reflects today’s scientific advances.
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