Intravenous immune globulin therapy in hypogammaglobulinemia

Pirofsky, Bernard

doi:10.1016/0002-9343(84)90320-6

Cited by 116 publications

(44 citation statements)

References 10 publications

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“…The efficacy and safety of IVIg [79,82,83] and SCIg [36,84,85] has been well established. Both treatment options appear to be safe, with comparative efficacy and costs.…”

Section: Choice Of Product and Administration Routementioning

confidence: 99%

Immunoglobulin treatment in primary antibody deficiency

Maarschalk-Ellerbroek

Hoepelman

Ellerbroek

2011

International Journal of Antimicrobial Agents

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The primary antibody deficiency syndromes are characterised by recurrent respiratory tract infections and the inability to produce effective immunoglobulin (Ig) responses. The best known primary antibody deficiencies are common variable immunodeficiency (CVID), X-linked agammaglobulinaemia (XLA), immunoglobulin G (IgG) subclass deficiency, and selective antibody deficiency with normal immunoglobulins (SADNI).Therapy in these patients consists of prophylactic antibiotics and/or Ig replacement therapy. Diagnostic delay remains common owing to limited awareness of the presenting features and may result in increased morbidity and mortality. Replacement therapy with immunoglobulins increases life expectancy and reduces the frequency and severity of infections, but the effect on end-organ damage is still unknown. Both intravenous immunoglobulin (IVIg) and subcutaneous immunoglobulin (SCIg) treatment appear to be safe, with comparable efficacy. A starting dose of 300-400 mg/kg/month in IVIg and 100 mg/week for SCIg is recommended. IgG trough levels should be >5 g/L for patients with agammaglobulinaemia and 3 g/L greater than the initial IgG level for patients with CVID; however, the clinical response should be foremost in choosing the dose and trough level. Infusion-related adverse reactions are generally mild owing to improved manufacturing processes. In this paper, aspects of Ig replacement therapy in primary antibody-deficient patients will be addressed.

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“…The efficacy and safety of IVIg [79,82,83] and SCIg [36,84,85] has been well established. Both treatment options appear to be safe, with comparative efficacy and costs.…”

Section: Choice Of Product and Administration Routementioning

confidence: 99%

Immunoglobulin treatment in primary antibody deficiency

Maarschalk-Ellerbroek

Hoepelman

Ellerbroek

2011

International Journal of Antimicrobial Agents

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“…When the IgG concentration is increased, however, as would be the case following massive i.v. dosing for certain indications (5,15,16,19,31), binding to IgG may assume potential clinical importance. This effect will be enhanced further in the presence of hypoalbuminemia.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of ceftriaxone binding to immunoglobulin G and potential clinical significance

Sun

Chow

Maderazo

1991

Antimicrob Agents Chemother

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The interaction between immunoglobulin G (IgG) and ceftriaxone was studied. Using an ultrafiltration method, we performed dose ranging studies at a ceftriaxone concentration range of 1 to 720 ,ug/ml kidney, the latter almost exclusively by glomerular filtration (2,14,24). Its elimination half-life is about 8 h (2,25,26). The relatively long half-life is at least partly a direct consequence of its substantial protein binding and the absence of renal tubular secretion (2, 25). MATERIALS AND METHODSFree concentrations of ceftriaxone (Cf) were determined by ultrafiltration (23,30) by using the CETRIFREE micropartition system (Amicon Division, W. R. Grace & Co., Beverly, Mass.). Samples were equilibrated for 30 min at 37°C and were then centrifuged at 1,500 x g for 20 min. The free concentration was determined from the ultrafiltrate.The ceftriaxone concentrations in the ultrafiltrate and in phosphate-buffered saline (PBS) were determined by the spectrophotometric method (model 250; Gilford Instrument Laboratories Inc., Oberlin, Ohio). The maximum absorption wavelength of ceftriaxone in PBS, ultrafiltered PBS, ultrafiltered IgG in PBS solution, and ultrafiltered albumin in PBS solution was 240 nm. At a concentration of 1 jig/ml, the within-day coefficients of variation were 0.36% in PBS buffer solution and 2.91% in ultrafiltered IgG or ultrafiltered albumin solutions. The overall day-to-day coefficient of variation was 4.5%, which was obtained for slopes of standard curves over a 4-month period. The ceftriaxone concentration in plasma ultrafiltrate was determined at a wavelength of 275 nm. At this wavelength, a plasma ultrafiltrate blank has a very low absorption. Drug-free samples were used as blank controls for all drug concentration determinations.Preliminary experiments indicated that ceftriaxone does not bind to the filter membrane, regardless of whether PBS or plasma ultrafiltrate is used as the solvent medium. Consequently, PBS buffer was used as the solvent medium in subsequent experiments.Binding of ceftriaxone to IgG and/or albumin. The binding

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“…An average increment of 200% is reached after the administration of a 100 mg/kg body weight dose (Buckley, 1982). A decrease of 20-30% in the post-infusion serum immunoglobulin peak has been measured after 24 h (Pirofsky, 1984). After a steady exponential decrease that lasts for 21-28 days, baseline pre-infusion concentrations are reached.…”

Section: Pharmacologymentioning

confidence: 97%

“…These symptoms are also dependent on the rate of immunoglobulin infusion. Stabilizing agents such as maltose in the immunoglobulin preparation may reduce aggregates and symptoms (Ochs et aL, 1980;Pirofsky, 1984 Wadsworth and Hanson, 1976;Alving et aL, 1980;Burks et aL, 1986). Corticoids reduce adverse reactions to i.v.…”

Section: Allergic Reactionsmentioning

confidence: 99%

Intravenous immunoglobulin treatment of pregnant patients with unexplained recurrent abortions

Raziel

Herman²,

Bukovsky³

et al. 1996

Human Reproduction

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Intravenous immunoglobulins, first given to recurrent aborters with anti-phospholipid syndrome, have been administered to unexplained aborters since 1986. They probably have immunomodulatory properties beyond supplying blocking antibodies. When pregnancy was confirmed, women were started with a loading dose which was repeated every 3-4 weeks until the second trimester. Dosages were empirical. Pregnancy rates ranged between 50 and 82%. The main maternal complications, i.e. allergic reactions and infections, were rare.

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Intravenous immune globulin therapy in hypogammaglobulinemia

Cited by 116 publications

References 10 publications

Immunoglobulin treatment in primary antibody deficiency

Immunoglobulin treatment in primary antibody deficiency

Characteristics of ceftriaxone binding to immunoglobulin G and potential clinical significance

Intravenous immunoglobulin treatment of pregnant patients with unexplained recurrent abortions

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