Recovering autonomy is a key advantage of home-based immunoglobulin therapy in patients with myositis

Abstract

Immunoglobulins are 2nd or 3rd-line treatments in dermatomyositis (DM) or polymyositis (PM) refractory to high-dose corticosteroids and immunosuppressants. Immunoglobulins (2 g/kg/mo) are usually administered intravenously (IVIg) once a month and the patients stay at hospital for a few days. Recently, subcutaneous injections (SCIg) were proposed 2 to 3 times per week, in some dysimmune diseases. SCIg are administered at home preferably by the patient or by a nurse. We investigated the needs and attitudes of DM and PM patients with experience of IVIg and SCIg. Seven patients (6 PM and 1 DM) from a single center participated in a focus group (N = 6) or underwent in-depth interview (N = 1). Six had the experience of both IVIg at hospital and SCIg at home; 1 has received only IVIg at hospital. Verbatim was recorded and transcribed for further content analysis and computer-aided textual analysis. Clinical profiles and stories were heterogeneous. At diagnosis, muscle weakness, severe pain, and fatigue were at the forefront of patients’ complaints impairing daily life. Patients reported considerable improvement with immunoglobulins. SCIg were described as easy, less disruptive for daily life, well tolerated, and less time-consuming. SCIg self-administration at home restored the feeling of autonomy and control. Interviews of DM and PM patients revealed that recovering autonomy and control was a central advantage of home-based SCIg that were efficient, well tolerated, and perceived as a good compromise between treatment burden and efficacy.

Intravenous immunoglobulin as an important adjunct in the prevention and therapy of coronavirus 2019 disease

“…As widely reported in literature, IVIg has a beneficial effect in several and distinct autoimmune disorders 84‐86 . In recent years, conventional (SCIg) and facilitated (fSCIg) subcutaneous immunoglobulin has been proposed as another therapeutic option to restore immune system imbalance in selected autoimmune diseases such as inflammatory myopathies 87‐90 . Since recent studies explore the hypothesis that SARS‐CoV‐2 may act as a trigger in the development of autoimmune or autoinflammatory disorders, another interesting use of IVIg is linked to the positive results obtained in several autoimmune diseases induced by SARS‐CoV‐2 91‐93 …”

“…[84][85][86] In recent years, conventional (SCIg) and facilitated (fSCIg) subcutaneous immunoglobulin has been proposed as another therapeutic option to restore immune system imbalance in selected autoimmune diseases such as inflammatory myopathies. [87][88][89][90] Since recent studies explore the hypothesis that SARS-CoV-2 may act as a trigger in the development of autoimmune or autoinflammatory disorders, another interesting use of IVIg is linked to the positive results obtained in several autoimmune diseases induced by SARS-CoV-2. [91][92][93] Holding the widest single-strand RNA among organisms, Coronaviruses' transcriptome retains a vast ability to interact with our defence system.…”

The Choice between Intravenous and Subcutaneous Immunoglobulins: Aspects for Consideration

“…Despite clinical benefits of IVIG or SCIG therapies, the need for repetitive infusion treatments, eventually in the setting of clinical visits can negatively impact the quality of life (QoL) of patients [71][72][73]. For patients who successfully manage home-based administration of SCIG, Administrated subcutaneously [70] Treatment location Hospital, doctor office, or infusion center [70] Home treatment by a health care professional [79] Home self-treatment [70] Administration Requires a health care professional [82] Administered by patient or caregiver after instruction by a health care professional [ More flexibility and independency [72,74] Costs More expensive than SCIG at high doses and if therapy is given over a long period of time [81,82,85,88,89] Potential to be more cost-effective in certain markets than IVIG for long-term therapy [81,82,85,88,89] the gain of flexibility and autonomy might add value and increase their QoL [71,[74][75][76]. In a conjoint survey including 252 adult patients and 66 parents of children with PID, both groups preferred a home setting, monthly frequency, fewer needle sticks, and shorter treatment durations of IG treatment relative to alternative choices (p < 0.05) [77].…”

Up-to-date treatment and management of myositis

“…SCIG have also been evaluated from the perspective of patients. In a study, six patients who had the experience of both IVIG at hospital and SCIG at home were interviewed about these treatments [22]. Patients reported considerable improvement with immunoglobulins.…”