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Intravenous and Subcutaneous Immunoglobulin Replacement: A Two-Way Road. Optimizing Healthcare Quality in Patients with Primary Immunodeficiencies

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Abstract

Purpose

To evaluate the alternate use of subcutaneous immunoglobulin (SCIG) and intravenous immunoglobulin (IVIG) in patients with primary immunodeficiencies (PID) in a third-level Pediatric University Hospital.

Methods

Retrospective study of all patients receiving SCIG from 2006 to 2012. Data collected included demographics, date SCIG was started, date of switch to IVIG and reasons, administration tolerance, and related adverse events. Effectiveness was defined as the lack of severe infections.

Results

Twenty-three patients (15 male, 8 female) with PID were studied. SCIG was initiated at a median age of 14.2 years (8.4 months-25.7 years) and median duration on SCIG treatment was 41 months (4-68). Nine patients (39.1%) temporarily switched from SCIG to IVIG for the following reasons: vacation (8), administration issues (1), and transient need for immunomodulatory therapy (1). A mean of 5.2 IVIG infusions/patient (SD=2.86) was administered while on SCIG. IVIG-related adverse events were documented in 3 patients with 6 infusions. Eight (34.8%) patients definitively discontinued SCIG use for the following reasons: convenience (5), adverse effects (1), coagulopathy (1), and autoimmune thrombocytopenia (1). There were no severe infections requiring hospital admission in any patient during the study period.

Conclusions

Alternating SCIG and IVIG use in patients with PID was associated with considerable advantages in terms of convenience for the patients and their caregivers, while maintaining the effectiveness and safety of this therapy. Healthcare units treating these patients should show flexibility with this dual therapy in order to optimize patients’ quality of life.

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Acknowledgments

We want to thank all the patients and their families for their contribution, and Celine Cavallo for English language support.

P.S.P. and A.F.P. participated in conducting the study and in writing and reviewing the manuscript, I.G.G. participated in writing and reviewing the manuscript, A.M.N. contributed to conducting the study and reviewing the manuscript, M.O.A. and C.F.N. reviewed the manuscript. All the authors have read and approved the text submitted.

Author Disclosure Statement

Pere Soler-Palacín has received several grants from CSL Behring and has participated as principal investigator in clinical trials by Baxter, Octapharma, and CSL Behring.

Conflict of Interest

All the other authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron. Institut de Recerca Vall d’Hebron. Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron, 119-129, 08035, Barcelona, Spain

    Pere Soler-Palacín, Andrea Martín-Nalda & Concepció Figueras

  2. Pharmacy Department, Vall d’Hebron Hospital, Barcelona, Spain

    Ingrid Gasó-Gago, Aurora Fernández-Polo, María Oliveras & Julio Martinez-Cutillas

Authors
  1. Pere Soler-Palacín
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  2. Ingrid Gasó-Gago
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  3. Aurora Fernández-Polo
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  4. Andrea Martín-Nalda
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  5. María Oliveras
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  6. Julio Martinez-Cutillas
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  7. Concepció Figueras
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Corresponding author

Correspondence to Pere Soler-Palacín.

Additional information

This study was funded by a grant (Ig-MAPS 2012) from CSL Behring.

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Soler-Palacín, P., Gasó-Gago, I., Fernández-Polo, A. et al. Intravenous and Subcutaneous Immunoglobulin Replacement: A Two-Way Road. Optimizing Healthcare Quality in Patients with Primary Immunodeficiencies. J Clin Immunol 34, 1015–1017 (2014). https://doi.org/10.1007/s10875-014-0096-2

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  • DOI: https://doi.org/10.1007/s10875-014-0096-2

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