Facilitated subcutaneous immunoglobulin (fSCIg) therapy – practical considerations

Abstract

SummaryThere is an increasing range of therapeutic options for primary antibodydeficient patients who require replacement immunoglobulin. These include intravenous immunoglobulin (IVIg), subcutaneous immunoglobulin (SCIg), rapid push SCIg and most recently recombinant human hyaluronidasefacilitated SCIg (fSCIg). Advantages of fSCIg include fewer needle punctures, longer infusion intervals and an improved adverse effect profile relative to IVIg. Limited real-life experience exists concerning the practical aspects of switching or starting patients on fSCIg. We describe the first 14 patients who have been treated with fSCIg at the Immunodeficiency Centre for Wales (ICW), representing more than 6 patient-years of experience. The regimen was well tolerated, with high levels of satisfaction and no increase in training requirement, including for a treatment-naive patient. Two patients discontinued fSCIg due to pain and swelling at the infusion site, and one paused therapy following post-infusion migraines. Ultrasound imaging of paired conventional and facilitated SCIg demonstrated clear differences in subcutaneous space distribution associated with a 10-fold increase in rate and volume delivery with fSCIg. Patient profiles for those choosing fSCIg fell into two main categories: those experiencing clinical problems with their current treatment and those seeking greater convenience and flexibility. When introducing fSCIg, consideration of the type and programming of infusion pump, needle gauge and length, infusion site, up-dosing schedule, home training and patient information are important, as these may differ from conventional SCIg. This paper provides guidance on practical aspects of the administration, training and outcomes to help inform decision-making for this new treatment modality.

“Experiences of the burden of treatment”—Patient reports of facilitated subcutaneous immunoglobulin treatment in adults with immunodeficiency

“…This was also confirmed by Ponsford et al. () which described that using fSCIg treatment offers a significant reduction in the number of needle sticks in comparison with SCIg treatment (Ponsford et al., ). A call for a person‐centred treatment of patients with immunodeficiency highlights the importance of input from patients’ experiences and discussions about their preferences in decision‐making when choosing the most appropriate therapy.…”

“…Again, convenience plays a large role in patient preferences, as it has been shown in this study that less frequent administrations of shorter durations and fewer needle sticks impact the patients' experiences. This was also confirmed by Ponsford et al (2015) which described that using fSCIg treatment offers a significant reduction in the number of needle sticks in comparison with SCIg treatment (Ponsford et al, 2015). A call for a personcentred treatment of patients with immunodeficiency highlights the importance of input from patients' experiences and discussions about their preferences in decision-making when choosing the most appropriate therapy.…”

“…To our knowledge, only Ponsford et al. () have reported that patients describe higher levels of satisfaction regarding the treatment with fSCIg (Ponsford et al., ).…”

“…Still, few data are available about patients' self-reported experiences of fSCIg treatment and the tolerability described from patients themselves. To our knowledge, only Ponsford et al (2015) have reported that patients describe higher levels of satisfaction regarding the treatment with fSCIg (Ponsford et al, 2015).…”

II Brazilian Consensus on the use of human immunoglobulin in patients with primary immunodeficiencies

“…139,140 In this setting, it is possible to inject subcutaneous Ig every 21 to 28 days, just like intramuscular injections, with appropriate safety and good clinical results. 19 Doses must be gradually increased over 7 weeks, which limits the use of this product when initial IgG levels are too low (<200mg/dL).…”