Immunoglobulin administration for the treatment of CIDP: IVIG or SCIG?

Abstract

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired neurological disorder characterized clinically by weakness and impaired sensory function evolving over 2 months or more, loss or significant decrease in deep tendon reflexes, and by electrophysiological evidence of peripheral nerve demyelination. Expeditious diagnosis and treatment of CIDP early in the disease course is critical such that irreversible disability can be avoided. Intravenous immunoglobulin (IVIG) is one first-line and maintenance therapy option for CIDP. The US Food & Drug Administration's (FDA's) approval of subcutaneous immunoglobulin (SCIG) in 2018 provides patients with CIDP more treatment options for maintenance therapy. The different options for administration of IG treatment create the need for information to assist clinicians and patients in choosing the optimal therapeutic approach. Considerations for pharmacokinetics, administration procedures, adverse events, patient variables, and cost will all be discussed in this article.

Home-based subcutaneous immunoglobulin for chronic inflammatory demyelinating polyneuropathy patients: A Swiss cost-minimization analysis

“…This is also the case in Denmark, where the difference is even larger (Privigen 1 = 111€/g versus Hizentra 1 = 77€/g) [35], but not in France (40€ versus 45€) [36] or in Belgium (44€ versus 48€) [37]. In the US study, the cost per gram of Gamunex-C 1 was much lower than that of Hizentra 1 (111€ versus 154€) [17]. These prices are negotiated at the national level and can be a political lever to encourage the switch or not.…”

“…Systemic side effects of SCIg are considered similar to those of IVIg, although the frequency and severity of SCIg are generally lower [17,20]. As each individual dose administered by SCIg is smaller than IVIg, a reduction in side effects is expected, which could reduce the total cost.…”

“…These results confirmed the cost advantage in favour of SCIg, with the same IgG dose in both strategies, from a local health service [16] and from a societal perspective [15]. A recent study from the United States showed a cost advantage over three weeks for lower dose SCIg (0.2 g/kg/week) but not for higher dose SCIg (0.4 g/kg/week) compared to IVIg (1 g/kg/week), primarily due to the higher cost per gram of Hizentra 1 compared with Gamunex-C 1 (Grifols Therapeutics) [17]. In the Swiss context, a previous costminimization analysis performed for PID patients, including the same interprofessional drug therapy management programme, estimated the total savings from switching to SCIg at 9,630 CHF per patient over three years from the societal perspective.…”

“…Moreover, in a pandemic situation, the home setting avoids bringing chronic patients to the hospital for treatment. Most authors recommend presenting each patient with the potential advantages and disadvantages of both alternatives with respect to individual preferences and competencies [17,19].…”

“…SCIg is also often preferred by patients over IVIg, as it is associated to better satisfaction and quality of life [5][6][7]. Previous studies have shown than SCIg has the potential to be cost-effective in different countries for both PID patients [8][9][10][11][12][13][14] and CIDP patients [15][16][17]. The findings are sensitive to the national context, and more importantly, the cost of patients training and follow-up is often overlooked.…”