Home-based immunoglobulin therapy acceptable in primary immunodeficiency

By Stephanie Leveene

Subcutaneous immunoglobulin (SCIg) therapy, administered at home, is an acceptable substitute for hospital-based intravenous immunoglobulin (IVIg) in patients with immune deficiencies, according to recent findings published in the Journal of Clinical Immunology.

Treatment with SCIg has recently emerged as an alternative to IVIg in immunocompromised adults and children, as it allows for faster administration and fewer systemic complications, explain Hans Ochs (Children's Hospital Research Institute, Seattle, Washington, USA), and colleagues.

Furthermore, patient-administered SCIg is now seen as an option for those who need relatively low Ig concentrations as well as patients with chronic renal disease, cardiovascular problems, or thrombophilic conditions.

However, there has been a lack of comprehensive data comparing all aspects of home-based SCIg versus hospital-based IVIg.

Ochs and team therefore conducted a systematic review of 47 studies comparing IVIg with SCIg. These studies encompassed 1028 patients, about two-thirds of whom were adults.

A meta-analysis of the studies found that treatment with SCIg led to trough IgG levels similar to those seen with IVIg, and doses needed to achieve the monthly required IgG concentrations were about the same for both agents. The serious infection rate was nonsignificantly lower with SCIg than with IVIg and there was a decrease in systemic adverse events (eg, fever, severe headache) with SCIg therapy.

The studies showed that patients found SCIg injections easier to control and schedule and were better tolerated overall. Patient satisfaction improved as well, and there is significant cost savings following a switch to home-based SCIg therapy.

The investigators conclude that due to the acceptable serum IgG levels achieved with SCIg treatment and the other advantages noted, "it makes sense to consider changing Ig substitution therapy from IVIg to SCIg in patients willing and able to self infuse at home."

However, they note that many of the studies they reviewed were not randomized and that some patients may have participated because they were unhappy with IVIg therapy. Therefore, there is a "need for additional well controlled, randomized clinical studies addressing some of these unresolved issues."

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