Subcutaneous IgG in immune-mediate diseases: proposed mechanisms of action and literature review

Danieli, Maria Giovanna; Gelardi, Chiara; Pedini, Veronica; Moretti, Romina; Gabrielli, Armando; Logullo, Francesco

doi:10.1016/j.autrev.2014.08.018

Cited by 35 publications

(19 citation statements)

References 59 publications

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“…Recent research into applications of SCIg in non-primary immunodeficiencies has focused primarily on CIPD and inflammatory myopathies (polymyositis, dermatomyositis) in adults [90][91][92]. Preliminary studies in small numbers of patients in primarily European studies suggest improved tolerability, patient satisfaction, and cost in the disease stabilization period of these disorders [90,[93][94][95], although long-term efficacy and randomized controlled studies are unavailable, and these studies were performed in patients who received SCIg after IVIG.…”

Section: Role Of Subcutaneous Immunoglobulin (Scig)mentioning

confidence: 97%

“…Preliminary studies in small numbers of patients in primarily European studies suggest improved tolerability, patient satisfaction, and cost in the disease stabilization period of these disorders [90,[93][94][95], although long-term efficacy and randomized controlled studies are unavailable, and these studies were performed in patients who received SCIg after IVIG. Moreover, there are speculative theoretical advantages of achieving peak IgG levels via IVIG in the acute phase of diseases like KD and ITP, and IVIG has been proposed to primarily target the humoral immune component whereas SCIg is postulated to better target the cellular component of the immune modulatory response [91].…”

Section: Role Of Subcutaneous Immunoglobulin (Scig)mentioning

confidence: 99%

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Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

Wong

White

2015

Clinic Rev Allerg Immunol

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Intravenous immunoglobulin (IVIG) provides replacement therapy in immunodeficiency and immunomodulatory therapy in inflammatory and autoimmune diseases. This paper describes the immune mechanisms underlying six major non-primary immunodeficiency pediatric diseases and the diverse immunomodulatory functions of IVIG therapy. In Kawasaki disease, IVIG plays a major, proven, and effective role in decreasing aneurysm formation, which represents an aberrant inflammatory response to an infectious trigger in a genetically predisposed individual. In immune thrombocytopenia, IVIG targets the underlying increased platelet destruction and decreased platelet production. Although theoretically promising, IVIG shows no clear clinical benefit in the prophylaxis and treatment of neonatal sepsis. Limitations in research design combined with the unique neonatal immunologic environment offer explanations for this finding. Inflammation from aberrant immune activation underlies the myelinotoxic effects of Guillain-Barré syndrome. HIV-1 exerts a broad range of immunologic effects and was found to decrease serious bacterial infections in the pre-highly active anti-retroviral therapy (HAART) era, although its practical relevance in the post-HAART era has waned. Clinical and experimental data support the role of immune mechanisms in the pathogenesis of childhood epilepsy. IVIG exerts anti-epileptic effects through targeting upregulated cytokine pathways and antibodies thought to contribute to epilepsy. Applications in six additional pediatric diseases including pediatric asthma, atopic dermatitis, cystic fibrosis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS), autism, and transplantation will also be briefly reviewed. From autoimmunity to immunodeficiency, a dynamic immunologic basis underlies major pediatric diseases and highlights the broad potential of IVIG therapy.

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Section: Role Of Subcutaneous Immunoglobulin (Scig)mentioning

confidence: 97%

Section: Role Of Subcutaneous Immunoglobulin (Scig)mentioning

confidence: 99%

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

Wong

White

2015

Clinic Rev Allerg Immunol

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“…In 2012, because of a worsening of the gastroenteric in- by patients [2,15,16]. SCIg have been usefully employed in various immune-mediated disorders, such as chronic inflammatory demyelinating neuropathy, multifocal motor neuropathy, other than primary and acquired immunodeficiency [15,17,18].…”

Section: Discussionmentioning

confidence: 99%

A Case of Refractory Dysphagia in the Context of Polymyositis Treated with Subcutaneous Immunoglobulin and Review of the Literature

Vacchi¹

2017

Clin Med Rev Case Rep

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Polymyositis (PM) is a systemic inflammatory disease affecting muscles and several other organs, including gastrointestinal system, in which the main symptom is dysphagia.Here, we describe a case of a 57-years-old woman presenting a difficult-to-manage dysphagia related to polymyositis, treated with benefit with Subcutaneous Immunoglobulins (SCIg). Beyond symptomatic therapies, immunosuppressive therapies (glucocorticoids, methotrexate, azathioprine, mycophenolatemofetil, and cyclosporine) are the main treatment of PM related dysphagia. Nowadays, few data are available to evaluate effectiveness and safety of intravenous immunoglobulins on esophageal involvement in refractory PM and only anecdotal cases are reported about the use of SCIg in the treatment of dysphagia in inflammatory myopathies (including inclusion body myositis). Up to date, this is the second observation describing an improvement of dysphagia in a subject affected by PM treated with SCIg; further studies are needed to evaluate the effectiveness of SCIg in the management of these patients.

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“…5 Some authors have also reported effectiveness of ScIg therapy in inflammatory myopathies and neuropathic diseases. 6 However, it has been proposed that modifying immunoglobulin dose and route of administration could change its interaction with the immune system. 6 Therefore, it is not known whether ScIg has the same effects and indications as IvIg.…”

Section: Introductionmentioning

confidence: 99%

“…6 However, it has been proposed that modifying immunoglobulin dose and route of administration could change its interaction with the immune system. 6 Therefore, it is not known whether ScIg has the same effects and indications as IvIg. In a literature review, we could not find any case report or series of SLE patients treated with ScIg.…”

Section: Introductionmentioning

confidence: 99%

Successful treatment of systemic lupus erythematosus with subcutaneous immunoglobulin

Brasileiro

Oliveira

Pinheiro

et al. 2016

Lupus

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The therapeutic efficacy of high-dose intravenous immunoglobulin in systemic lupus erythematosus (SLE) patients is well established. However, side effects might limit its use and lead to the consideration of therapeutic alternatives, such as the subcutaneous formulation of immunoglobulin, which has been used in some patients with other autoimmune diseases. We report a case of SLE refractory to classical therapies. High-dose intravenous immunoglobulin was effective, but gave rise to significant side effects. The patient was successfully treated with subcutaneous human immunoglobulin, achieving and maintaining clinical and laboratory remission. A lower immunoglobulin dose was needed and no side effects were observed, compared to the intravenous administration. Subcutaneous immunoglobulin could be a better-tolerated and cost-saving therapeutic option for select SLE patients. Lupus (2016) 25, 663-665.

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Subcutaneous IgG in immune-mediate diseases: proposed mechanisms of action and literature review

Cited by 35 publications

References 59 publications

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

A Case of Refractory Dysphagia in the Context of Polymyositis Treated with Subcutaneous Immunoglobulin and Review of the Literature

Successful treatment of systemic lupus erythematosus with subcutaneous immunoglobulin

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