Skip to main content

Advertisement

Log in

Comparative Study of Subcutaneous Versus Intravenous IgG Replacement Therapy in Pediatric Patients with Primary Immunodeficiency Diseases: A Multicenter Study in Argentina

  • Original Research
  • Published:
Journal of Clinical Immunology Aims and scope Submit manuscript

Abstract

Purpose

Several studies have shown that subcutaneous immunoglobulin (SCIG) infusions demonstrate similar efficacy to intravenous Ig (IVIG) in preventing infections in patients with primary immunodeficiency diseases (PID), and are safe and well tolerated in this population. This open, prospective/retrospective, multicenter study was designed to compare the effectiveness, safety and tolerability of a 16 % liquid human IgG preparation (Beriglobina P), administered SC, with previous IVIG treatment in PID pediatric patients in Argentina.

Methods

Fifteen subjects were enrolled in the study, and a total of 13 subjects (aged 6–18 years) completed the 36-week SCIG treatment period. All children had previously received IVIG treatment. The dose of SCIG equaled the previous IVIG dose and subjects received an average weekly dose of 139 mg/kg (range 105–181) during the SCIG period.

Results

Significantly higher serum IgG trough levels were recorded on SCIG treatment at 16, 24, and 36 weeks, when compared with previous IgG trough levels on steady-state IVIG treatment. The annualized infection rate was 1.4 infections/subject/year during the IVIG administration period compared with 0.4 infections/subject/year during the SCIG period. All subjects who completed the study chose to continue administering SCIG at home after the study had ended.

Conclusions

These data confirm that self-administered SCIG therapy is a well-tolerated and effective alternative to IVIG therapy for children with PID.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Notarangelo LD, Fischer A, Geha RS, Casanova JL, Chapel H, Conley ME, et al. Primary immunodeficiencies: 2009 update. J Allergy Clin Immunol. 2009;124(6):1161–78. doi:10.1016/j.jaci.2009.10.013.

    Article  PubMed  CAS  Google Scholar 

  2. Borte S, Janzi M, Pan-Hammarstrom Q, von Dobeln U, Nordvall L, Winiarski J, et al. Placental transfer of maternally-derived IgA precludes the use of guthrie card eluates as a screening tool for primary immunodeficiency diseases. PLoS One. 2012;7(8):e43419. doi:10.1371/journal.pone.0043419.

    Article  PubMed  CAS  Google Scholar 

  3. Al-Herz W, Bousfiha A, Casanova JL, Chapel H, Conley ME, Cunningham-Rundles C, et al. Primary immunodeficiency diseases: an update on the classification from the international union of immunological societies expert committee for primary immunodeficiency. Front Immunol. 2011;2:54. doi:10.3389/fimmu.2011.00054.

    Article  PubMed  Google Scholar 

  4. Borte S, von Dobeln U, Hammarstrom L. Guidelines for newborn screening of primary immunodeficiency diseases. Curr Opin Hematol. 2013;20(1):48–54. doi:10.1097/MOH.0b013e32835a9130.

    Article  PubMed  CAS  Google Scholar 

  5. Chapel HM, Spickett GP, Ericson D, Engl W, Eibl MM, Bjorkander J. The comparison of the efficacy and safety of intravenous versus subcutaneous immunoglobulin replacement therapy. J Clin Immunol. 2000;20(2):94–100.

    Article  PubMed  CAS  Google Scholar 

  6. Yong PL, Boyle J, Ballow M, Boyle M, Berger M, Bleesing J, et al. Use of intravenous immunoglobulin and adjunctive therapies in the treatment of primary immunodeficiencies: a working group report of and study by the Primary Immunodeficiency Committee of the American Academy of Allergy Asthma and Immunology. Clin Immunol. 2010;135(2):255–63. doi:10.1016/j.clim.2009.10.003.

    Article  PubMed  CAS  Google Scholar 

  7. Orange JS, Hossny EM, Weiler CR, Ballow M, Berger M, Bonilla FA, et al. Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol. 2006;117(4 Suppl):S525–53. doi:10.1016/j.jaci.2006.01.015.

    Article  PubMed  CAS  Google Scholar 

  8. Gardulf A, Nicolay U, Asensio O, Bernatowska E, Bock A, Carvalho BC, et al. Rapid subcutaneous IgG replacement therapy is effective and safe in children and adults with primary immunodeficiencies—a prospective, multi-national study. J Clin Immunol. 2006;26(2):177–85. doi:10.1007/s10875-006-9002-x.

    Article  PubMed  CAS  Google Scholar 

  9. Gardulf A, Hammarstrom L, Smith CI. Home treatment of hypogammaglobulinaemia with subcutaneous gammaglobulin by rapid infusion. Lancet. 1991;338(8760):162–6.

    Article  PubMed  CAS  Google Scholar 

  10. Berger M. Subcutaneous immunoglobulin replacement in primary immunodeficiencies. Clin Immunol. 2004;112(1):1–7. doi:10.1016/j.clim.2004.02.002.

    Article  PubMed  CAS  Google Scholar 

  11. Toubi E, Etzioni A. Intravenous immunoglobulin in immunodeficiency states: state of the art. Clin Rev Allergy Immunol. 2005;29(3):167–72. doi:10.1385/CRIAI:29:3:167.

    Article  PubMed  CAS  Google Scholar 

  12. Berger M. Subcutaneous administration of IgG. Immunol Allergy Clin North Am. 2008;28(4):779–802, viii. doi:10.1016/j.iac.2008.07.002.

    Article  PubMed  Google Scholar 

  13. Ochs HD, Gupta S, Kiessling P, Nicolay U, Berger M. Safety and efficacy of self-administered subcutaneous immunoglobulin in patients with primary immunodeficiency diseases. J Clin Immunol. 2006;26(3):265–73. doi:10.1007/s10875-006-9021-7.

    Article  PubMed  CAS  Google Scholar 

  14. Gardulf A. Immunoglobulin treatment for primary antibody deficiencies: advantages of the subcutaneous route. BioDrugs: clinical immunotherapeutics, biopharmaceuticals and gene therapy. 2007;21(2):105–16.

  15. Gardulf A, Andersen V, Bjorkander J, Ericson D, Froland SS, Gustafson R, et al. Subcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: safety and costs. Lancet. 1995;345(8946):365–9.

    Article  PubMed  CAS  Google Scholar 

  16. Nicolay U, Kiessling P, Berger M, Gupta S, Yel L, Roifman CM, et al. Health-related quality of life and treatment satisfaction in North American patients with primary immunedeficiency diseases receiving subcutaneous IgG self-infusions at home. J Clin Immunol. 2006;26(1):65–72. doi:10.1007/s10875-006-8905-x.

    Article  PubMed  CAS  Google Scholar 

  17. Fasth A, Nystrom J. Safety and efficacy of subcutaneous human immunoglobulin in children with primary immunodeficiency. Acta Paediatr. 2007;96(10):1474–8. doi:10.1111/j.1651-2227.2007.00485.x.

    Article  PubMed  Google Scholar 

  18. Gardulf A, Nicolay U, Math D, Asensio O, Bernatowska E, Bock 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. doi:10.1016/j.jaci.2004.06.053.

    Article  PubMed  CAS  Google Scholar 

  19. Gardulf A, Borte M, Ochs HD, Nicolay U. 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. doi:10.1016/j.clim.2007.06.009.

    Article  PubMed  CAS  Google Scholar 

  20. Abrahamsen TG, Sandersen H, Bustnes A. Home therapy with subcutaneous immunoglobulin infusions in children with congenital immunodeficiencies. Pediatrics. 1996;98(6 Pt 1):1127–31.

    PubMed  CAS  Google Scholar 

  21. Bhole MV, Burton J, Chapel HM. Self-infusion programmes for immunoglobulin replacement at home: feasibility, safety and efficacy. Immunol Allergy Clin North Am. 2008;28(4):821–32, ix. doi:10.1016/j.iac.2008.06.005.

    Article  PubMed  Google Scholar 

  22. Borte M, Bernatowska E, Ochs HD, Roifman CM. Efficacy and safety of home-based subcutaneous immunoglobulin replacement therapy in paediatric patients with primary immunodeficiencies. Clin Exp Immunol. 2011;164(3):357–64. doi:10.1111/j.1365-2249.2011.04376.x.

    Article  PubMed  CAS  Google Scholar 

  23. Maroto Hernando M, Soler Palacin P, Martin Nalda N, Oliveras Arenas M, Espanol Boren T, Figueras Nadal C. Subcutaneous gammaglobulin in common variable immunodeficiency. First experience in Spain. An Pediatr (Barc). 2009;70(2):111–9. doi:10.1016/j.anpedi.2008.11.011.

    Article  CAS  Google Scholar 

  24. Conley ME, Notarangelo LD, Etzioni A. Diagnostic criteria for primary immunodeficiencies. Representing PAGID (Pan-American Group for Immunodeficiency) and ESID (European Society for Immunodeficiencies). Clin Immunol. 1999;93(3):190–7.

    Article  PubMed  CAS  Google Scholar 

  25. Sorensen RU, Leiva LE, Javier 3rd FC, Sacerdote DM, Bradford N, Butler B, et al. Influence of age on the response to Streptococcus pneumoniae vaccine in patients with recurrent infections and normal immunoglobulin concentrations. J Allergy Clin Immunol. 1998;102(2):215–21.

    Article  PubMed  CAS  Google Scholar 

  26. FDA. Safety, efficacy, and pharmacokinetic studies to support marketing of immune globulin intravenous (human) as replacement therapy for primary humoral immunodeficiency. Guidance for industry; 2008. FDA. 2008. http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm072130.htm. Accessed 5 Sept 2012.

  27. Gaspar J, Gerritsen B, Jones A. Immunoglobulin replacement treatment by rapid subcutaneous infusion. Arch Dis Child. 1998;79(1):48–51.

    Article  PubMed  CAS  Google Scholar 

  28. Hagan JB, Fasano MB, Spector S, Wasserman RL, Melamed I, Rojavin MA, et al. Efficacy and safety of a new 20% immunoglobulin preparation for subcutaneous administration, IgPro20, in patients with primary immunodeficiency. J Clin Immunol. 2010;30(5):734–45. doi:10.1007/s10875-010-9423-4.

    Article  PubMed  CAS  Google Scholar 

  29. Waniewski J, Gardulf A, Hammarstrom L. Bioavailability of gamma-globulin after subcutaneous infusions in patients with common variable immunodeficiency. J Clin Immunol. 1994;14(2):90–7.

    Article  PubMed  CAS  Google Scholar 

  30. Jolles S, Bernatowska E, de Gracia J, Borte M, Cristea V, Peter HH, et al. Efficacy and safety of Hizentra((R)) in patients with primary immunodeficiency after a dose-equivalent switch from intravenous or subcutaneous replacement therapy. Clin Immunol. 2011;141(1):90–102. doi:10.1016/j.clim.2011.06.002.

    Article  PubMed  CAS  Google Scholar 

  31. Berger M. Principles of and advances in immunoglobulin replacement therapy for primary immunodeficiency. Immunol Allergy Clin North Am. 2008;28(2):413–37, x. doi:10.1016/j.iac.2008.01.008.

    Article  PubMed  Google Scholar 

  32. Haddad E, Berger M, Wang EC, Jones CA, Bexon M, Baggish JS. Higher doses of subcutaneous IgG reduce resource utilization in patients with primary immunodeficiency. J Clin Immunol. 2012;32(2):281–9. doi:10.1007/s10875-011-9631-6.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant from CSL Behring. The editorial assistance of PHOCUS Services Ltd, part of the Fishawack Group of Companies, supported by CSL Behring is acknowledged.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Liliana Bezrodnik.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bezrodnik, L., Gómez Raccio, A., Belardinelli, G. et al. Comparative Study of Subcutaneous Versus Intravenous IgG Replacement Therapy in Pediatric Patients with Primary Immunodeficiency Diseases: A Multicenter Study in Argentina. J Clin Immunol 33, 1216–1222 (2013). https://doi.org/10.1007/s10875-013-9916-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10875-013-9916-z

Keywords

Navigation