Subcutaneous immunoglobulin replacement therapy with Hizentra®, the first 20% SCIG preparation: a Practical approach

Abstract

To reduce the risk of infection in adults and children with primary immunodeficiencies, replacement therapy with IgG, which can be administered to patients intravenously or subcutaneously, is required. Although

CANO-ACIO CLINICAL LECTURESHIP The development and implementation of a subcutaneous immunoglobulin (SCIG) program at CancerCare Manitoba

“…Subcutaneous therapy is a well-established route of administration for immunoglobulin replacement therapy in Europe and across Canada (Jolles & Sleasman, 2011). Subcutaneous immunoglobulin (SCIG) has primarily been used in immunology to treat primary and secondary immunodeficiency.…”

“…Hizentra is not a medication dispensed from pharmacies but rather a blood derivative dispensed from hospital blood banks. Hizentra is preservative-free with only trace amounts of IgA, 20% concentration and stable at room temperature (Jolles & Sleasman, 2011). Hizentra is more concentrated than previous products, which translates to a smaller volume required per infusion.…”

“…SCIG can be administered using either the push method with syringe and butterfly needle or with the assistance of an infusion pump. The push method is a quick, simple and affordable method to adopt while infusion pumps may be preferable for patients who require large volume infusions or who have issues with dexterity (Jolles & Sleasman, 2011).…”

“…In dosing patients with SCIG at CCMB, we consider the same principles for IVIG dosing: dosing by weight (400mg/ kg) or standard low dosing. In primary immune deficiency, patients are dosed by weight and titrated to achieve trough levels within the therapeutic window to minimize infectious complications (Jolles & Sleasman, 2011;Orange et al, 2012).…”

“…SCIG is very well tolerated with only 7% of patients experiencing fever and fewer experiencing headaches, nausea or dizziness (Compagno, Malipiero, Cinetto, & Agnostini, 2014). The most commonly reported side effect is a local infusion site reaction (edema, erythema, and itching), which, in most cases, is mild and managed with antihistamines and Figure 1: Subcutaneous infusion sites analgesia (Jolles & Sleasman, 2011) (see Figure 2). Moderate and severe side effects are uncommon, and monitoring of vital sign monitoring is not required.…”