Subject: subcutaneous IVIG
Subcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: safety and costs.
Gardulf A, Andersen V, Bjorkander J, Ericson D, Froland SS, Gustafson R, Hammarstrom L, Jacobsen MB, Jonsson E, Moller G, et al.
Department of Clinical Immunology, Karolinska Institute, Huddinge University Hospital, Sweden.
Immunoglobulins (IgG) as replacement therapy in primary antibody deficiencies can be given as intramuscular injections, or as intravenous or subcutaneous infusions. Our aims were to obtain information on the frequency of adverse systemic reactions during subcutaneous therapy, the occurrence and intensity of tissue reactions at the infusion sites, and serum IgG
changes. hypogammaglobulinaemia or IgG-subclass deficiencies.
No severe or anaphylactoid reactions occurred. Despite large immunoglobulin volumes given during 434 patient years (28,480 infusions), no signs have been found that indicate the transmission of hepatitis virus. Transient tissue reactions occurred at the infusion sites but were not troublesome to most patients and we found significant increases in mean serum IgG. The use of subcutaneous instead of intravenous infusions at home would reduce the yearly cost per patient for the health-care sector by US $10,100 in Sweden alone. We conclude that subcutaneous administration of IgG is a safe and convenient method of providing immunoglobulins. We were able to reach serum IgG concentrations similar to those by the intravenous therapy and we found that the method could also be used successfully in patients with previous severe or anaphylactoid reactions to intramuscular injections.
Subcutaneous immunoglobulin infusion: a new therapeutic option in chronic inflammatory demyelinatingpolyneuropathy.
Department of Neurology at St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany.
Intravenous application of immunoglobulins (IVIg) is an effective and usually well tolerated yet costly therapeutic regimen in chronic inflammatorydemyelinating polyneuropathy (CIDP). We report two CIDP patients treated with subcutaneous infusion of immunoglobulins (SCIg) after IVIg therapy was shown to be effective. Application of SCIg was well tolerated, easy to manage, and led to stabilization of the disease course. SCIg may represent an effective new therapeutic option in CIDP and is associated with a cost reduction of at least 50% compared to IVIg therapy.
Immunomodulatory therapy to achieve maximum efficacy: doses, monitoring, compliance, and self-infusion at home.
Department of Clinical Immunology, John Radcliffe Hospital, Level 4A, Oxford, UK.
The Oxford Programme for Immunomodulatory Immunoglobulin Therapy has been operating since 1992 at Oxford Radcliffe Hospitals in the UK. Initially, this program was set up for patients with multifocal motor neuropathy or chronic inflammatory demyelinating poly-neuropathy to receive reduced doses of intravenous immunoglobulin (IVIG) in clinic on a regular basis (usually every 3 weeks). The program then rapidly expanded to include self-infusion at home, which monitoring showed to be safe and effective. It has been since extended to the treatment of other autoimmune diseases in which IVIG has been shown to be efficacious.
This review includes details of the program such as the training of patients, dosing with immunoglobulin, and monitoring and compliance for self-infusion at home, with cases to illustrate these points.
In addition, the Evidence for efficacy and the effects of confounding morbidities will be are included described. More recently,subcutaneous immunoglobulin therapy (SCIG) has been used in several chronic autoimmune peripheral neuropathies and in epidermolysis bullosa acquisita, with equally good effect. Trials of SCIG in other autoimmune diseases are planned.
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