Subcutaneous Immunoglobulin Replacement Therapy Experience with Intravenous Preparation

Objective: Intravenous immunoglobulin preparations have been used in the treatment of primary immunodeficiency for many years. Recently, immunoglobulin administration via the subcutaneous route has become popular. Subcutaneously administered immunoglobulin provides more stable serum immunoglobulin levels and has a lower incidence of systemic adverse effects than the intravenous route. This method increases the quality of the patient’s life by self administration or parental administration at home. Immunoglobulin preparations designed for subcutaneous administration have been available in Europe and the US since 2006. Although subcutaneous immunoglobulin preparations are not available in Turkey, the subcutaneous administration route has recently been included in the instructions of the three intravenous products with 10% concentration. Our aim was to use one of these intravenous immunoglobulin preparations via the subcutaneous route and describe its advantages and disadvantages. Materials and Methods: Six primary immunodeficiency patients were selected from our clinic. The procedure was described and informed consent obtained. They had been treated with intravenous immunoglobulin for the last few years. Their monthly immunoglobulin dosage was calculated and roughly divided into weekly doses. The first few administrations took place under medical supervision at the hospital until the patients and/or their family learned the procedure. Results: They were encouraging with fewer side effects, better life quality and lower infection rates in our small sample of patients. Conclusion: In this article, we describe our experience with 6 primary immunodeficiency patients of our clinic in whom we successfully used intravenous immunoglobulin preparation via the subcutaneous route

Kaynakça

1. Bruton OC. Agammaglobulinemia. Pediatrics 1952;9:722-8. 2. McCusker C, Warrington R. Primary immunodeficiency. Allergy Asthma Clin Immunol 2011;7 Suppl 1:S11.

3. Gitlin D, Janeway CA. Agammaglobulinemia, congenital, acquired and transient forms. Prog Hematol 1956;1:318-29.

4. Berger M, Cupps TR, Fauci AS. Immunoglobulin replacement therapy by slow subcutaneous infusion. Ann Intern Med 1980;93(1):55-6.

5. Hammarstrom L, Gardulf A, Hammarstrom V, Janson A, Lindberg K, Smith CIE. Systemic and topical immunoglobulin treatments in immunocompromised patients. Immunol Rev 1994;139:43-70.

6. Özdemir Ö, Bingöl-Aydın D. Subcutaneous immunoglobulin replacement therapy with intravenous preparation in primary immunodeficiency patients. MOJ Immunol 2016;3(2):00080 (abstract).

7. Thampakkul S, Ballow M. Replacement intravenous immune serum globulin therapy in patients with antibody immune deficiency. Immunol Allergy Clin North Am 2001;21:165-84.

8. Gardulf A, Nicolay U, Math D, Asensio O, Bernatowska E, Böck A, et al. Children and adults with primary antibody deficiencies gain quality of life by subcutaneous IgG self-infusions at home. J Allergy Clin Immunol 2004;114(4):936-42.

9. Radinsky S, Bonagura VR. Subcutaneous immunoglobulin infusion as an alternative to intravenous immunoglobulin. J Allergy Clin Immunol 2003;112(3):630-3.

10. Berger M. Subcutaneous immunoglobulin replacement in primary immunodeficiencies. Clin Immunol 2004;112(1):1-7.

11. Abrahamsen TG, Sandersen H, Bustnes A. Home therapy with subcutaneous immunoglobulin infusions in children with congenital immunodeficiencies. Pediatrics 1996;98:1127-31.

12. Lucas M, Lee M, Lortan J, Lopez-Granados E, Misbah S, Chapel H. Infection outcomes in patients with common variable immunodeficiency disorders: Relationship to immunoglobulin therapy over 22 years. J Allergy Clin Immunol 2010;125:1354- 60, e1354.

13. Gardulf A, Borte M, Ochs HD, Nicolay U; Vivaglobin Clinical Study Group. Prognostic factors for health-related quality of life in adults and children with primary antibody deficiencies receiving SCIG home therapy. Clin Immunol 2008;126(1):81-8.

14. Wasserman RL, Melamed I, Kobrynski L, Strausbaugh SD, Stein MR, Sharkhawy M, et al. Efficacy, safety, and pharmacokinetics of a 10% liquid immune globulin preparation (GAMMAGARD LIQUID, 10%) administered subcutaneously in subjects with primary immunodeficiency disease. J Clin Immunol 2011;31(3):323-31.

15. Fu LW, Song C, Isaranuwatchai W, Betschel S. Home-based subcutaneous immunoglobulin therapy vs hospital-based intravenous immunoglobulin therapy: A prospective economic analysis. Ann Allergy Asthma Immunol 2018;120(2):195-9.

16. Bonilla FA. Intravenous and subcutaneous immunoglobulin G replacement therapy. Allergy Asthma Proc 2016; 37(6):426-31.

17. Karakoç Aydıner E, Kıykım A, Barış S, Özen A, Barlan I. Use of subcutaneous immunoglobulin in primary immune deficiencies. Turk Pediatri Ars 2016; 51(1):8-14.

Kaynak Göster