Skip to main content

Advertisement

SpringerLink
Log in

Subcutaneous immunoglobulin dose titration to clinical response in inflammatory neuropathy

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Introduction

Individualized dosing is an established approach in intravenous immunoglobulin (IVIg) treatment for inflammatory neuropathies. There is less experience in effective dosing strategies for subcutaneous (SC) immunoglobulin.

Methods

We conducted a retrospective cohort study of patients with inflammatory neuropathies transferring from IVIg to SCIg in two UK peripheral nerve services. I-RODS and grip strength were used to measure outcome. Dose and clinical progress were documented at 1 year and at last review.

Results

44/56 patients remained on maintenance SCIg beyond 1 year (mean 3.3 years, range 1–9 years) with stable clinical outcomes. Clinical deteriorations were corrected by small increases in SCIg dose in 20 patients at 1 year, a further 9 requiring subsequent further up-titrations. Sixteen tolerated dose reduction. Mean dose change was + 2.4% from baseline. Two patients required IVIg bolus rescue (2 g/kg). Three patients successfully discontinued Ig therapy. Nine patients returned to IVIg due to clinical relapse or patient preference. Overall tolerance was good.

Discussion

Dose titration to clinical response is an effective approach in SCIg maintenance therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

  1. van Schaik IN et al (2018) Subcutaneous immunoglobulin for maintenance treatment in chronic inflammatory demyelinating polyneuropathy (PATH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 17:35–46

    Article  Google Scholar 

  2. Yoon M-S, Gold R, Kerasnoudis A (2015) Subcutaneous immunoglobulin in treating inflammatory neuromuscular disorders. Ther Adv Neurol Disord 8:153–159

    Article  CAS  Google Scholar 

  3. Markvardsen LH et al (2014) Subcutaneous immunoglobulin preserves muscle strength in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 21:1465–1470

    Article  CAS  Google Scholar 

  4. Chen Y, Wang C, Xu F, Ming F, Zhang H (2019) Efficacy and Tolerability of Intravenous Immunoglobulin and Subcutaneous Immunoglobulin in Neurologic Diseases. Clin Ther. 41(10):2112–2136. https://doi.org/10.1016/j.clinthera.2019.07.009

    Article  CAS  PubMed  Google Scholar 

  5. Cocito D et al (2014) Subcutaneous immunoglobulin in CIDP and MMN: a short-term nationwide study. J Neurol 261:2159–2164

    Article  CAS  Google Scholar 

  6. Allen JA, Gelinas DF, Freimer M, Runken MC, Wolfe GI (2020) Immunoglobulin administration for the treatment of CIDP: IVIG or SCIG? J Neurol Sci. 15(408):116497. https://doi.org/10.1016/j.jns.2019.116497

    Article  CAS  Google Scholar 

  7. MP L et al (2016) A proposed dosing algorithm for the individualized dosing of human immunoglobulin in chronic inflammatory neuropathies. J Peripher Nerv Syst 21:33–37

    Article  Google Scholar 

  8. Berger M, Allen JA (2015) Optimizing IgG therapy in chronic autoimmune neuropathies: a hypothesis driven approach. Muscle Nerve 51:315–326

    Article  CAS  Google Scholar 

  9. Eftimov F, Vermeulen M, de Haan RJ, van den Berg LH, van Schaik IN (2009) Subcutaneous immunoglobulin therapy for multifocal motor neuropathy. J Peripher Nerv Syst 14:93–100

    Article  CAS  Google Scholar 

  10. Misbah SA et al (2011) A smooth transition protocol for patients with multifocal motor neuropathy going from intravenous to subcutaneous immunoglobulin therapy: an open-label proof-of-concept study. J Peripher Nerv Syst 16:92–97

    Article  CAS  Google Scholar 

  11. Department of Health (2011). Clinical guidelines for immunoglobulin use: update to second edition

  12. Van Den Bergh PYK et al (2010) European federation of neurological societies/peripheral nerve society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European federation of neurological societies and the peripher. J Peripher Nerv Syst 15:1–9

    Google Scholar 

  13. Van Schaik INN et al (2010) European federation of neurological societies/peripheral nerve society guideline on management of multifocal motor neuropathy. Report of a joint task force of the European federation of neurological societies and the peripheral nerve society: first revis. J Periphe Nerv Syst 15:295–301

    Article  Google Scholar 

  14. Draak THP et al (2016) Correlation of the patient’s reported outcome Inflammatory-RODS with an objective metric in immune-mediated neuropathies. Eur J Neurol 23:1248–1253

    Article  CAS  Google Scholar 

  15. Draak THP et al (2015) Grip strength comparison in immune-mediated neuropathies: vigorimeter vs Jamar. J Peripher Nerv Syst 20:269–276

    Article  Google Scholar 

  16. van Schaik IN et al (2016) Subcutaneous immunoglobulin for maintenance treatment in chronic inflammatory demyelinating polyneuropathy (The PATH Study): study protocol for a randomized controlled trial. Trials 17:1–15

    Article  Google Scholar 

  17. Hadden RDM, Marreno F (2015) Switch from intravenous to subcutaneous immunoglobulin in CIDP and MMN: improved tolerability and patient satisfaction. Ther Adv Neurol Disord 8:14–19

    Article  Google Scholar 

  18. Kuitwaard K et al (2017) Maintenance IV immunoglobulin treatment in chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 22:425–432

    Article  CAS  Google Scholar 

  19. Suleman A et al (2019) Evaluation of a personalized subcutaneous immunoglobulin treatment program for neurological patients. Can J Neurol Sci J Can Des Sci Neurol 46:38–43

    Article  Google Scholar 

  20. Markvardsen LH, Harbo T (2017) Subcutaneous immunoglobulin treatment in CIDP and MMN. Efficacy, treatment satisfaction and costs. J Neurol Sci 378:19–25

    Article  CAS  Google Scholar 

  21. Lazzaro C, Lopiano L, Cocito D (2014) Subcutaneous vs intravenous administration of immunoglobulin in chronic inflammatory demyelinating polyneuropathy: an Italian cost-minimization analysis. Neurol Sci 35:1023–1034

    Article  Google Scholar 

  22. Cocito D et al (2016) Subcutaneous immunoglobulin in CIDP and MMN: a different long-term clinical response? J Neurol Neurosurg Psychiatry 87:791–793

    Article  Google Scholar 

  23. Gentile L et al (2020) Long-term treatment with subcutaneous immunoglobulin in patients with chronic inflammatory demyelinating polyradiculoneuropathy: a follow-up period up to 7 years. Sci Rep 10:7910

    Article  CAS  Google Scholar 

  24. Markvardsen LH et al (2013) Subcutaneous immunoglobulin in responders to intravenous therapy with chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Neurol 20:836–842

    Article  CAS  Google Scholar 

Download references

Acknowledgements

MK gratefully received funding from a patient’s bequest. Professor Reilly is grateful to the Medical Research Council (MRC), MRC Centre grant (G0601943), and the National Institutes of Neurological Diseases and Stroke and office of Rare Diseases (U54NS065712) for their support. Dr Lunn and Dr Carr are also supported by the National Institute for Health Research University College London Hospitals Biomedical Research.

Author information

Authors and Affiliations

  1. MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

    Mahima Kapoor, Laura Compton, Hadi Manji, Mary M. Reilly, Michael P. Lunn & Aisling S. Carr

  2. Manchester Centre for Clinical Neurosciences, Salford Royal Hospital Trust, Stott Lane, Salford, UK

    Ryan Keh, Sarah Morrow, David Gosal & Tim M. Lavin

Authors
  1. Mahima Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan Keh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Compton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah Morrow
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Gosal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hadi Manji
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mary M. Reilly
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael P. Lunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tim M. Lavin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Aisling S. Carr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aisling S. Carr.

Ethics declarations

Conflicts of interest

Dr. Lunn was a Primary Investigator in studies for CSL Behring, UCB Pharma, Novartis, and Octapharma. He has also received ad hoc consulting fees from CSL Behring, UCB and an honorarium from Terumo BCT. Dr. Carr reports Grifols sponsorship for attendance at meeting and honorarium from CSL and Lupin for an advisory role. Dr Lavin reports sponsorship from CSL Behring and honorarium from CSL Behring and Grifols. Dr Kapoor reports Grifols sponsorship for attendance at meeting. The remaining authors have no conflicts of interest.

Ethical approval

We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kapoor, M., Keh, R., Compton, L. et al. Subcutaneous immunoglobulin dose titration to clinical response in inflammatory neuropathy. J Neurol 268, 1485–1490 (2021). https://doi.org/10.1007/s00415-020-10318-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-020-10318-3

Keywords

Search

Navigation