Current treatment options with immunoglobulin G for the individualization of care in patients with primary immunodeficiency disease

Abstract

SummaryPrimary antibody deficiencies require lifelong replacement therapy with immunoglobulin (Ig)G to reduce the incidence and severity of infections. Both subcutaneous and intravenous routes of administering IgG can be effective and well tolerated. Treatment regimens can be individualized to provide optimal medical and quality-of-life outcomes in infants, children, adults and elderly people. Frequency, dose, route of administration, home or infusion-centre administration, and the use of self-or health-professionaladministered infusion can be tailored to suit individual patient needs and circumstances. Patient education is needed to understand the disease and the importance of continuous therapy. Both the subcutaneous and intravenous routes have advantages and disadvantages, which should be considered in selecting each patient's treatment regimen. The subcutaneous route is attractive to many patients because of a reduced incidence of systemic adverse events, flexibility in scheduling and its comparative ease of administration, at home or in a clinic. Self-infusion regimens, however, require independence and self-reliance, good compliance on the part of the patient/parent and the confidence of the physician and the nurse. Intravenous administration in a clinic setting may be more appropriate in patients with reduced manual dexterity, reluctance to self-administer or a lack of self-reliance, and intravenous administration at home for those with good venous access who prefer less frequent treatments. Both therapy approaches have been demonstrated to provide protection from infections and improve health-related quality of life. Data supporting current options in IgG replacement are presented, and considerations in choosing between the two routes of therapy are discussed.

A pilot study about subcutaneous administration of 10% immunoglobulin in patients with primary immune deficiencies: single center experience

“…Slowing down the infusion rate, distributing the infused total dose to more sites, increasing the frequency of infusion, local anesthetics application, changing the application site, selecting a fatty site, changing needle calibration, reviewing educations, use of hyaluronidase or changing the product have been recommended to decrease local reactions/side effects (24).…”

Use of subcutaneous immunoglobulin in primary immune deficiencies

“…The frequency of complaints vary according to the site selected, time of administration and the volume and concentration used, but they tend to decrease as the administration is continued (25). Decreasing the rate of infusion, increasing the number of the sites, increasing the frequency of infusion, applying local anesthetics, changing the application site, selecting a fatty site, selection of a 9-15 mm and 23-25 G needle in adults and a 4-6 mm and 24-27 G needle in children, reviewing educations, use of hyaluronidase or changing the product have been recommended to decrease these side effects (25). It was found that the complaints were eliminated with these measures in our patients.…”

Guía colombiana de práctica clínica para el uso de inmonuglobulinas en el tratamiento de reemplazo e inmunomodulación

“…Se pueden utilizar simultáneamente múltiples sitios de aplicación. (GRADE A1) 15,43,45,47,54,55 R La dosis de carga en pacientes que no hayan recibido previamente IgIV puede administrase por vía endovenosa en una sola aplicación de 1 g/kg. Si se elige la vía subcutánea, la dosis recomendada es 1 g/kg fraccionada en 3 a 5 aplicaciones en días consecutivos; después se debe continuar con las dosis semanales descritas.…”

“…Si se elige la vía subcutánea, la dosis recomendada es 1 g/kg fraccionada en 3 a 5 aplicaciones en días consecutivos; después se debe continuar con las dosis semanales descritas. (GRADE A1) 15,43,45,47,54,55 R No existen diferencias significativas en la efectividad cuando se comparan las diferentes presentaciones de IgIV disponibles en el mercado. En pacientes con enfermedades crónicas asociadas como diabetes, insuficiencia renal, enfermedades metabólicas, entre otras, se debe escoger el producto comercial, vía y dosis acordes con las comorbilidades y condiciones del paciente.…”