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Yalcin Gungoren E, Yorgun Altunbas M, Dikici U, Meric Z, Eser Simsek I, Kiykim A, Can S, Karabiber E, Yakici N, Orhan F, Cokugras H, Aydogan M, Ozdemir O, Bilgic Eltan S, Baris S, Ozen A, Karakoc-Aydiner E. Insights into Patient Experiences with Facilitated Subcutaneous Immunoglobulin Therapy in Primary Immune Deficiency: A Prospective Observational Cohort. J Clin Immunol 2024; 44:169. [PMID: 39098942 PMCID: PMC11298503 DOI: 10.1007/s10875-024-01771-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Immunoglobulin G replacement therapy (IgRT), intravenous (IV) and subcutaneous (SC) routes, is pivotal in treatment of primary immunodeficiencies (PID). In recent years, facilitated subcutaneous immunoglobulin (fSCIG), a combination of rHuPH20 and 10% IgG has emerged as a delivery method to combine advantages of both IV and SC. METHOD In an observational prospective cohort, we investigated patient experience with fSCIG in PID patients from 5 PID centers for up to 12 months. We assessed the efficacy and safety of this treatment with patient/caregiver- and physician-reported indicators. Additionally, we analyzed patient treatment satisfaction (TSQM-9) and quality of life (QoL). RESULTS We enrolled 29 patients (22 pediatric and 7 adults; 14 females and 15 males; (median: 15, min-max: 2-40.9 years) who initiated fSCIG as IgRT-naive (n = 1), switched from conventional rapid-push 10% SCIG (n = 6) or IVIG (n = 22). Among the participants, 19 (65%) exhibited antibody deficiencies, 8 (27%) combined immunodeficiencies, and 2 (7%) immune dysregulations. Remarkably, targeted trough immunoglobulin G levels were achieved under all previous IgRTs as well as fSCIG. No severe systemic adverse drug reactions were documented, despite prevalent local (%86.45) and mild systemic (%26.45) adverse reactions were noted with fSCIG. Due to mild systemic symptoms, 2 patients switched from fSCIG to 10% SCIG. The patient satisfaction survey revealed a notable increase at 2-4th (p = 0.102); 5-8th (p = 0.006) and 9-12th (p < 0.001) months compared to the baseline. No significant trends were observed in QoL surveys. CONCLUSION fSCIG demonstrates admissable tolerability and efficacy in managing PIDs in addition to notable increase of patients' drug satisfaction with IgRT. The identified benefits support the continuation of this therapy despite the local reactions.
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Affiliation(s)
- Ezgi Yalcin Gungoren
- Depatment of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
| | - Melek Yorgun Altunbas
- Depatment of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
| | - Ummugulsum Dikici
- Department of Pediatrics, Division of Allergy and Immunology, Sakarya University, Training and Research Hospital, Sakarya, Turkey
| | - Zeynep Meric
- Depatment of Pediatrics, Division of Allergy and Immunology, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Isil Eser Simsek
- Department of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayca Kiykim
- Depatment of Pediatrics, Division of Allergy and Immunology, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Salim Can
- Depatment of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
| | - Esra Karabiber
- Department of Chest Diseases, Division of Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nalan Yakici
- Depatment of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Fazil Orhan
- Depatment of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Haluk Cokugras
- Depatment of Pediatrics, Division of Allergy and Immunology, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Metin Aydogan
- Department of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Oner Ozdemir
- Department of Pediatrics, Division of Allergy and Immunology, Sakarya University, Training and Research Hospital, Sakarya, Turkey
| | - Sevgi Bilgic Eltan
- Depatment of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
| | - Safa Baris
- Depatment of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
| | - Ahmet Ozen
- Depatment of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
- The Isil Berat Barlan Center for Translational Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
| | - Elif Karakoc-Aydiner
- Depatment of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey.
- Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey.
- The Isil Berat Barlan Center for Translational Medicine, Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.
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Bril V, Hadden RDM, Brannagan TH, Bar M, Chroni E, Rejdak K, Rivero A, Andersen H, Latov N, Levine T, Pasnoor M, Sacconi S, Souayah N, Anderson-Smits C, Duff K, Greco E, Hasan S, Li Z, Yel L, Ay H. Hyaluronidase-facilitated subcutaneous immunoglobulin 10% as maintenance therapy for chronic inflammatory demyelinating polyradiculoneuropathy: The ADVANCE-CIDP 1 randomized controlled trial. J Peripher Nerv Syst 2023; 28:436-449. [PMID: 37314318 DOI: 10.1111/jns.12573] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS ADVANCE-CIDP 1 evaluated facilitated subcutaneous immunoglobulin (fSCIG; human immunoglobulin G 10% with recombinant human hyaluronidase) efficacy and safety in preventing chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) relapse. METHODS ADVANCE-CIDP 1 was a phase 3, double-blind, placebo-controlled trial conducted at 54 sites in 21 countries. Eligible adults had definite or probable CIDP and adjusted Inflammatory Neuropathy Cause and Treatment (INCAT) disability scores of 0-7 (inclusive), and received stable intravenous immunoglobulin (IVIG) for ≥12 weeks before screening. After stopping IVIG, patients were randomized 1:1 to fSCIG 10% or placebo for 6 months or until relapse/discontinuation. fSCIG 10% was administered at the same dose (or matching placebo volume) and interval as pre-randomization IVIG. The primary outcome was patient proportion experiencing CIDP relapse (≥1-point increase in adjusted INCAT score from pre-subcutaneous treatment baseline) in the modified intention-to-treat population. Secondary outcomes included time to relapse and safety endpoints. RESULTS Overall, 132 patients (mean age 54.4 years, 56.1% male) received fSCIG 10% (n = 62) or placebo (n = 70). CIDP relapse was reduced with fSCIG 10% versus placebo (n = 6 [9.7%; 95% confidence interval 4.5%, 19.6%] vs n = 22 [31.4%; 21.8%, 43.0%], respectively; absolute difference: -21.8% [-34.5%, -7.9%], p = .0045). Relapse probability was higher with placebo versus fSCIG 10% over time (p = .002). Adverse events (AEs) were more frequent with fSCIG 10% (79.0% of patients) than placebo (57.1%), but severe (1.6% vs 8.6%) and serious AEs (3.2% vs 7.1%) were less common. INTERPRETATION fSCIG 10% more effectively prevented CIDP relapse than placebo, supporting its potential use as maintenance CIDP treatment.
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Affiliation(s)
- Vera Bril
- The Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Thomas H Brannagan
- Neurological Institute, Columbia University, New York City, New York, USA
| | - Michal Bar
- University Hospital and Faculty of Medicine, Ostrava, Czechia
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Alberto Rivero
- Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | | | - Norman Latov
- Weill Cornell Medicine, New York City, New York, USA
| | | | - Mamatha Pasnoor
- The University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Nizar Souayah
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Kim Duff
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Erin Greco
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Shabbir Hasan
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Zhaoyang Li
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Leman Yel
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
| | - Hakan Ay
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
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In-line warming reduces in-line pressure of subcutaneous infusion of concentrated immunoglobulins. Drug Deliv Transl Res 2023:10.1007/s13346-023-01321-y. [PMID: 36920736 PMCID: PMC10382333 DOI: 10.1007/s13346-023-01321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
Immunoglobulin replacement therapy is a life-saving treatment in patients with immunodeficiency and effective in the management of autoimmune disorders. Immunoglobulins are administered intravenously or subcutaneously, with the latter route reducing systemic reactions and providing an option for self-infusion, increasing patient convenience, while decreasing patient burden, healthcare utilization, and costs. A major limitation with subcutaneous administrations is the frequency of infusion due to limited volumes administrable into subcutaneous space, necessitating increased drug concentration, absorption, and dispersion. Increasing the concentration of immunoglobulins from 10 to 20% halves the required volume, but leads to higher dynamic viscosity, limiting infusion rate. Recombinant human hyaluronidase increases dispersion and absorption of immunoglobulins allowing administration of ≤ 600 mL per site, but does not change viscosity. Since the viscosity of fluids depends on temperature, we tested the feasibility of in-line warming of immunoglobulin formulations to physiological temperatures. In vitro analysis showed no negative impact of in-line warming to 38 °C on product quality. Subcutaneous infusion studies in pigs confirmed the feasibility of infusion rates of up to 7.5 mL/min with in-line warmed TAK-881, an immunoglobulin 20% facilitated with recombinant human hyaluronidase. In-line pressures were reduced compared with conventional immunoglobulin 20%, and local tolerance was not altered. Reduction of in-line pressures was more pronounced with thinner needle sets, indicating a potential benefit for patients. In summary, an in in-line warming device can circumvent the limitation of high viscosity, while product quality and local tolerance are maintained. The results of the presented studies warrant further testing in a phase 1 clinical study.
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Bittner B. Drug delivery improvements to enable a flexible care setting for monoclonal antibody medications in oncology - Analogue-based decision framework. Expert Opin Drug Deliv 2023; 20:457-470. [PMID: 36855292 DOI: 10.1080/17425247.2023.2184343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION The substantial acceleration in healthcare spending together with the expenditures to manage the COVID19 pandemic demand drug delivery solutions that enable a flexible care setting for high-dose monoclonal antibodies (mAbs) in oncology. AREAS COVERED This expert opinion introduces an analogue-based framework applied to guide decision-making for associated product improvements for mAb medications that are either already authorized or in late-stage clinical development. The four pillars of this framework comprise (1) the drug delivery profile of current and emerging treatments in the market, (2) the needs and preferences of people treated with mAbs, (3) existing healthcare infrastructures, and (4) country-dependent reimbursement and procurement models. The following product optimization examples for mAb-based treatments are evaluated based on original research and review articles in the field: subcutaneous formulations, an established drug delivery modality to reduce parenteral dosing complexity, fixed-dose combinations, an emerging concept to complement combination therapy, and (connected) on-body delivery systems, an identified future opportunity to support dosing outside of a controlled healthcare institutional environment. EXPERT OPINION Leveraging existing synergies and learnings from other disease areas is a measure to reduce associated development and commercialization costs and thus to provide sustainable product offerings already at the initial launch of a medication.
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Affiliation(s)
- Beate Bittner
- Global Product Strategy - Product Optimization, F. Hoffmann-La Roche Ltd, Basel, Switzerland
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Gupta S, Kobayashi RH, Litzman J, Cherwin L, Hoeller S, Kreuwel H. Subcutaneous immunoglobulin 16.5% for the treatment of pediatric patients with primary antibody immunodeficiency. Expert Rev Clin Immunol 2023; 19:7-17. [PMID: 36346032 DOI: 10.1080/1744666x.2023.2144836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Human immunoglobulin (IG) administered intravenously (IVIG) or subcutaneously (SCIG) is used to prevent infections in patients with primary immunodeficiency diseases (PIDDs) such as primary antibody immunodeficiencies. AREAS COVERED This review provides an overview of PIDD with a focus on SCIG treatment, including the properties and clinical trial results of a new SCIG 16.5% (Cutaquig, Octapharma) in pediatric patients. We also discuss the various benefits of SCIG including stable serum immunoglobulin G levels, high tolerability with fewer systemic side effects, and the flexibility of self-administration. EXPERT OPINION Individualized treatment for PIDD in children is necessary given the different factors that affect administration of SCIG. Variables such as the dose, dosing interval, administration sites, and ancillary equipment can be adjusted to impact the long-term satisfaction with SCIG administration in pediatric patients. The successful work that has been conducted by both professional and patient organizations to increase awareness of PIDD, especially in pediatric patients, is substantial and ongoing. The importance of early diagnosis and treatment in the pediatric patient population cannot be overstated. The safety, efficacy, and tolerability of SCIG 16.5% have been demonstrated in pediatric patients with PIDDs providing an additional therapeutic option in this vulnerable population.
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Affiliation(s)
- Sudhir Gupta
- Division of Basic and Clinical Immunology, University of California, Irvine, Irvine, CA, USA
| | - Roger H Kobayashi
- School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jiří Litzman
- Department of Clinical Immunology and Allergology, St. Anne's University in Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Laurel Cherwin
- Scientific and Medical Affairs, Octapharma AG, Paramus, NJ, USA
| | - Sonja Hoeller
- Scientific and Medical Affairs, Octapharma AG, Paramus, NJ, USA
| | - Huub Kreuwel
- Scientific and Medical Affairs, Octapharma AG, Paramus, NJ, USA
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Wasserman RL, Cunningham-Rundles C, Anderson J, Lugar P, Palumbo M, Patel NC, Hofmann J, Glassman F, Rogers E, Praus M, Rojavin MA. Systemic IgG exposure and safety in patients with primary immunodeficiency: a randomized crossover study comparing a novel investigational wearable infusor versus the Crono pump. Immunotherapy 2022; 14:1315-1328. [PMID: 36128795 DOI: 10.2217/imt-2022-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: A novel, Investigational Wearable Infusor (IWI) was evaluated in a randomized, controlled, crossover, open-label study to determine if its delivery of subcutaneous immunoglobulin (IgPro20) achieved a comparable area under the concentration-time curve (AUC) for immunoglobulin G (IgG) versus the Crono S-PID-50 infusion pump (CP). EudraCT: 2016-003798-16. Materials & methods: Patients with primary immunodeficiency (PID) were randomized to receive IgPro20 in Sequence 1 (CP/IWI) or 2 (IWI/CP). The primary end point was AUC for IgG during the final week of each 4-week period. Results: 23 patients were enrolled. Evaluation of area under the concentration-time curve from time 0 (pre-infusion) to 7 days after infusion (AUC0-7 days) (IWI: 1806 h*g/l; CP: 1829 h*g/l) and geometric mean ratio indicated comparable AUCs for IgG for both devices. Conclusion: Similar IgG exposure, indicated by AUC values, can be achieved with IgPro20 using the IWI or CP in PID.
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Affiliation(s)
- Richard L Wasserman
- Allergy Partners of North Texas Research, 7777 Forest Lane, Suite B-332, Dallas, TX 75230, USA
| | - Charlotte Cunningham-Rundles
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA
| | - John Anderson
- Clinical Research Center of Alabama (a division of AllerVie Health), 504 Brookwood Blvd Suite 250, Birmingham, AL 35209, USA
| | - Patricia Lugar
- Departments of Medicine & Pediatrics, Division of Pulmonary, Allergy & Critical Medicine; Duke University Medical Center, Durham, NC 27705, USA
| | - Michael Palumbo
- Allergy & Clinical Immunology Associates, 180 Fort Couch Road, Pittsburgh PA 15241, USA
| | - Niraj C Patel
- Children's Healthcare of Atlanta, Division of Pulmonary, Allergy/Immunology, Cystic Fibrosis, & Sleep, Emory University School of Medicine, 1400 Tullie RD NE, Atlanta, GA 30329, USA
| | - Jutta Hofmann
- CSL Behring AG, Wankdorfstrasse 10, 3014, Bern, Switzerland
| | - Fiona Glassman
- CSL Behring LLC, 1020 First Avenue, King of Prussia, PA 19406, USA
| | - Eileen Rogers
- Enable Injections, Inc., 2863 E. Sharon Rd Cincinnati, OH 45241, USA
| | - Michaela Praus
- CSL Behring Innovation GmbH, Emil-von-Behring-Straße 76, 35041, Marburg, Germany
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Hipogammaglobulinemia crónica postrasplante de precursores hematopoyéticos y su tratamiento con gammaglobulina subcutánea en pacientes pediátricos. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Serra Font S, López-Granados L, Sisinni L, Serna Berna JV, Martínez Martínez L, Fernández de Gamarra-Martínez E, de la Calle Martín O, Badell Serra I. Chronic hypogammaglobulinemia after allogeneic stem cell transplantation and their treatment with subcutaneous immunoglobulin in pediatric patients. An Pediatr (Barc) 2022; 97:103-111. [PMID: 35869014 DOI: 10.1016/j.anpede.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hypogammaglobulinemia in the first months after allogeneic hematopoietic stem cell transplantation (HSCT) is common in paediatric patients. During this phase, replacement therapy with human immunoglobulin must be administered parenterally to prevent infections. In some cases, this hypogammaglobulinemia persists over time, which forces further treatment when the patient is usually no longer a carrier of a central line, making them ideal candidates for subcutaneous replacement therapy. There is little published literature describing the use of this method in paediatric patients undergoing HSCT, widely described in replacement treatment in children with primary immunodeficiencies with very good results. PATIENTS AND METHODS An observational, descriptive, longitudinal and retrospective study is carried out. During the years 2008-2019, we evaluated all paediatric patients undergoing HSCT in our center with persistent chronic hypogammaglobulinemia (for over a year). The treatment phase with intravenous immunoglobulin (Privigen®) and the first four years of treatment with subcutaneous immunoglobulin (Hizentra®) are evaluated using a questionnaire. RESULTS During the years 2008-2019, 175 patients underwent HSCT, 143 (82%) of whom exceeded three months after transplantation. Three (2%) of them had persistent hypogammaglobulinemia. All three share factors described in the literature involved in immune reconstitution. After analysing the questionnaire, it is observed that switching from intravenous to subcutaneous gammaglobulin has involved a great improvement in their quality of life. CONCLUSIONS The origin of chronic hypogammaglobulinemia in our patients shows different factors and cannot be attributed to a single cause. Due to the limited number of patients no conclusions can be drawn at the population level. We have been able to observe that replacement treatment with Hizentra 20% has been as effective as the intravenous administration without evidence of an increase in bacterial infections. Furthermore, it has also led to an improvement in quality of life and increased comfort, as the patients themselves have stated.
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Affiliation(s)
- Sara Serra Font
- Unidad Pediátrica De Hematología, Oncología y Trasplante Hematopoyético, Hospital De La Santa Creu i Sant Pau, Barcelona, Spain.
| | - Lucía López-Granados
- Unidad Pediátrica De Hematología, Oncología y Trasplante Hematopoyético, Hospital De La Santa Creu i Sant Pau, Barcelona, Spain
| | - Luisa Sisinni
- Unidad Pediátrica De Hematología, Oncología y Trasplante Hematopoyético, Hospital De La Santa Creu i Sant Pau, Barcelona, Spain
| | - José Vicente Serna Berna
- Unidad Pediátrica De Hematología, Oncología y Trasplante Hematopoyético, Hospital De La Santa Creu i Sant Pau, Barcelona, Spain; Instituto De Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Universidad Autónoma De Barcelona, Barcelona, Spain
| | - Laura Martínez Martínez
- Instituto De Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Universidad Autónoma De Barcelona, Barcelona, Spain; Servicio De Inmunología, Hospital De La Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Oscar de la Calle Martín
- Instituto De Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Universidad Autónoma De Barcelona, Barcelona, Spain; Servicio De Inmunología, Hospital De La Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabel Badell Serra
- Unidad Pediátrica De Hematología, Oncología y Trasplante Hematopoyético, Hospital De La Santa Creu i Sant Pau, Barcelona, Spain; Instituto De Investigaciones Biomédicas Sant Pau (IIB Sant Pau), Universidad Autónoma De Barcelona, Barcelona, Spain
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Kobayashi RH, Litzman J, Rizvi S, Kreuwel H, Hoeller S, Gupta S. Overview of subcutaneous immunoglobulin 16.5% in primary and secondary immunodeficiency diseases. Immunotherapy 2022; 14:259-270. [PMID: 34986666 DOI: 10.2217/imt-2021-0313] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Most primary immunodeficiency diseases, and select secondary immunodeficiency diseases, are treated with immunoglobulin (IG) therapy, administered intravenously or subcutaneously (SCIG). The first instance of IG replacement for primary immunodeficiency disease was a 16.5% formulation administered subcutaneously in 1952. While most SCIG products are now a 10 or 20% concentration, this review will focus on SCIG 16.5% products with a historical overview of development, including the early pioneers who initiated and refined IG replacement therapy, as well as key characteristics, manufacturing and clinical studies. In determining an appropriate IG regimen, one must consider specific patient needs, characteristics and preferences. There are advantages to SCIG, such as stable serum immunoglobulin G levels, high tolerability and the flexibility of self-administered home treatment.
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Affiliation(s)
| | - Jiří Litzman
- Department of Clinical Immunology & Allergology, St. Anne's University in Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | | | - Sonja Hoeller
- Octapharma Pharm. ProduduktionsgesmbH, Vienna, Austria
| | - Sudhir Gupta
- Division of Basic & Clinical Immunology, University of California, Irvine, CA, USA
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Santamaria M, Neth O, Douglass JA, Krivan G, Kobbe R, Bernatowska E, Grigoriadou S, Bethune C, Chandra A, Horneff G, Borte M, Sonnenschein A, Kralickova P, Ramón SS, Langguth D, Gonzalez-Granado LI, Alsina L, Querolt M, Griffin R, Hames C, Mondou E, Price J, Sanz A, Lin J. A Multi‑Center, Open‑Label, Single‑Arm Trial to Evaluate the Efficacy, Pharmacokinetics, and Safety and Tolerability of IGSC 20% in Subjects with Primary Immunodeficiency. J Clin Immunol 2022; 42:500-511. [PMID: 34973143 PMCID: PMC9016006 DOI: 10.1007/s10875-021-01181-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this phase 3 study was to evaluate the efficacy, pharmacokinetics (PK), and safety of Immune Globulin Subcutaneous (Human), 20% Caprylate/Chromatography Purified (IGSC 20%) in patients with primary immunodeficiency (PI). Methods Immunoglobulin treatment-experienced subjects with PI received 52 weeks of IGSC 20% given weekly at the same dose as the subject’s previous IgG regimen (DAF 1:1); the minimum dose was 100 mg/kg/week. The primary endpoint was serious bacterial infections (SBIs [null vs alternative hypothesis: SBI rate per person per year ≥ 1 vs < 1]). IgG subclasses and specific pathogen antibody levels were also measured. Results Sixty-one subjects (19 children [≤ 12 years], 10 adolescents [> 12–16 years], and 32 adults) were enrolled. The rate of SBIs per person per year was 0.017. The 1-sided 99% upper confidence limit was 0.036 (< 1), and the null hypothesis was rejected. The rate of hospitalization due to infection per person per year was 0.017 (2-sided 95% confidence interval: 0.008–0.033) overall. The mean trough total IgG concentrations were comparable to the previous IgG replacement regimen. The average of the individual mean trough ratios (IGSC 20%:previous regimen) was 1.078 (range: 0.83–1.54). The average steady-state mean trough IgG concentrations were 947.64 and 891.37 mg/dL, respectively. Seven subjects had serious treatment-emergent adverse events (TEAEs); none was drug-related. The rate of all TEAEs, including local infusion site reactions, during 3045 IGSC 20% infusions was 0.135. Most TEAEs were mild or moderate. Conclusions IGSC 20% demonstrated efficacy and good safety and tolerability in subjects with PI. Supplementary Information The online version contains supplementary material available at 10.1007/s10875-021-01181-6.
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Affiliation(s)
- Manuel Santamaria
- Unidad de Inmunologia Clinica, Hospital Universitario Reina Sofía, Facultad de Medicina, Universidad de Cordoba, Cordoba, Spain
| | - Olaf Neth
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica RITIP, IBiSSeville, Spain
| | - Jo A Douglass
- Department of Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Gergely Krivan
- Paediatric Haematology and Hemopoietic Stem Cell Transplantation Department, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Robin Kobbe
- First Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ewa Bernatowska
- Department of Immunology, Children's Memorial Health Institute, Warsaw, Poland
| | - Sofia Grigoriadou
- Department of Immunology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Claire Bethune
- Peninsula Immunology and Allergy Service, University Hospitals Plymouth, Plymouth, UK
| | - Anita Chandra
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Gerd Horneff
- Asklepios Kinderklinik Sankt Augustin, Sankt Augustin, Germany.,University Hospital of Cologne, Cologne, Germany
| | - Michael Borte
- Klinikum St Georg GmbH, Klinik für Kinder- und Jugendmedizin, Leipzig, Germany
| | - Anja Sonnenschein
- Department of Pediatric Immunology and Rheumatology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Pavlina Kralickova
- Department of Allergology and Clinical Immunology, Faculty of Medicine, Charles University and University Hospital in Hradec Kralove, Hradec Kralove, Czechia
| | | | - Daman Langguth
- Immunology Department, Sullivan Nicolaides Pathology, Brisbane, Australia
| | - Luis Ignacio Gonzalez-Granado
- Primary Immunodeficiencies Unit, Hospital Universitario 12 de Octubre and Department of Public and Maternal - Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain. .,Institut de Recerca Sant Joan de Déu, Barcelona, Spain. .,Universitat de Barcelona, Barcelona, Spain.
| | - Montse Querolt
- Grifols Bioscience Research Group, Sant Cugat del Vallès, Barcelona, Spain
| | - Rhonda Griffin
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
| | - Carrie Hames
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
| | - Elsa Mondou
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
| | - Jeffrey Price
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
| | - Ana Sanz
- Grifols Bioscience Research Group, Sant Cugat del Vallès, Barcelona, Spain
| | - Jiang Lin
- Grifols Bioscience Research Group, NC, Research Triangle Park, USA
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11
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Imai K, Ishii T, Nonoyama S, Yasumi T, Kanegane H, Fukushima T, Matsumaru M, Akasaki T, Usui H. Real-world results with IgPro20 for hypo- or agammaglobulinemia in Japan. Pediatr Int 2022; 64:e15362. [PMID: 36151913 PMCID: PMC10099597 DOI: 10.1111/ped.15362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Subcutaneous immunoglobulin is one of the standard treatments for hypogammaglobulinemia in primary immunodeficiencies (PID) worldwide. In Japan, IgPro20 (Hizentra® ; l-proline-stabilized 20% human subcutaneous immunoglobulin) is approved for agammaglobulinemia or hypogammaglobulinemia due to PID or secondary immunodeficiency (SID); however, its safety and effectiveness has not previously been assessed in a real-world setting. METHODS This multicenter, open label post-marketing surveillance study was conducted between January 2014 and March 2019. Patients who received IgPro20 due to PID or SID were included after informed consent. Physicians completed a case report form for each patient. Safety was determined from reported adverse events (AEs), adverse drug reactions, and serious AEs (SAEs); effectiveness was assessed by infection rates after the first IgPro20 dose. RESULTS Of 85 patients receiving IgPro20 in the safety analysis, 39 developed AEs (45.9%; PID n = 28, SID n = 11). At least one adverse drug reaction was observed in 27 patients (31.8%; PID n = 21, SID n = 6), and the most common were injection site reactions (n = 17, 20.0%). Four patients (PID n = 3, SID n = 1) reported SAEs but two were unrelated to IgPro20 administration. The infection rate decreased from 0.54 per patient during the 6 months before IgPro20 to 0.39 per patient during IgPro20 treatment. Serious bacterial infections occurred in six patients before IgPro20 (7.9%; PID n = 2; SID n = 4) but in only one patient with SID during IgPro20 treatment (1.2%). CONCLUSIONS In Japan, IgPro20 was considered safe and effective among patients with agammaglobulinemia or hypogammaglobulinemia due to PID or SID.
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Affiliation(s)
- Kohsuke Imai
- Department of Community Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomonori Ishii
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Miyagi, Japan
| | - Shigeaki Nonoyama
- Department of Pediatrics, National Defense Medical College, Saitama, Japan
| | - Takahiro Yasumi
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirokazu Kanegane
- Department of Child Health and Development, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | | | | | | | - Hideo Usui
- Department of Pharmacovigilance, CSL Behring K.K., Tokyo, Japan
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12
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Bus SRM, Wieske L, Keddie S, van Schaik IN, Eftimov F. Subcutaneous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Hippokratia 2021. [DOI: 10.1002/14651858.cd014542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sander RM Bus
- Department of Neurology, Amsterdam Neuroscience; Amsterdam UMC, University of Amsterdam; Amsterdam Netherlands
| | - Luuk Wieske
- Department of Neurology, Amsterdam Neuroscience; Amsterdam UMC, University of Amsterdam; Amsterdam Netherlands
| | - Stephen Keddie
- Faculty of Brain Sciences; Institute of Neurology; London UK
| | - Ivo N van Schaik
- Department of Neurology, Amsterdam Neuroscience; Amsterdam University Medical Centers, location AMC, University of Amsterdam; Amsterdam Netherlands
| | - Filip Eftimov
- Department of Neurology, Amsterdam Neuroscience; Amsterdam UMC, University of Amsterdam; Amsterdam Netherlands
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13
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Hustad NB, Degerud HM, Hjelmerud I, Fraz MSA, Nordøy I, Trøseid M, Fevang B, Aukrust P, Jørgensen SF. Real-World Experiences With Facilitated Subcutaneous Immunoglobulin Substitution in Patients With Hypogammaglobulinemia, Using a Three-Step Ramp-Up Schedule. Front Immunol 2021; 12:670547. [PMID: 34012453 PMCID: PMC8127781 DOI: 10.3389/fimmu.2021.670547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Immunoglobulin replacement therapy with facilitated subcutaneous immunoglobulin (fSCIg) can be self-administrated at home and given at longer intervals compared to subcutaneous immunoglobulin (SCIg) therapy, but real-word experience of home-based fSCIg therapy is limited. Herein we present our real-word clinical experiences with home-based fSCIg therapy using a three-step ramp-up schedule. We registered data from all patients with immunodeficiency starting fSCIg from 01.01.2017 to 31.12.2019. For comparison we also included patients starting conventional SCIg training. Fifty-four patients followed for a median of 18 months (IQR 12, range 0-40), received fSCIg training, and 84 patients received conventional SCIg training. Out of 54 patients starting with fSCIg, 41 patients had previous experience with conventional SCIg therapy, and the main reason for starting fSCIg was 'longer intervals between therapies' (n=48). We found an increase in training requirement for fSCIg (3 ± 1 [2-9] days) compared to conventional SCIg (2 ± 0 [1-7] days), P< 0.001 (median ± IQR, [range]). For fSCIg training, IgG levels were stable from baseline (8.9 ± 2.3 g/L), 3-6 months (10.2 ± 2.2 g/L) and 9-12 months (9.9 ± 2.3 g/L), P= 0.11 (mean ± SD). The most common side-effect was: 'rubor around injection site' (n=48, 89%). No patients experienced severe adverse events (grade 3-4). Thirteen patients (24%) discontinued fSCIg therapy due to local adverse events (n=9), cognitive/psychological difficulties (n=6) and/or systemic adverse events (n=3). In conclusion, fSCIg training using a three-step ramp-up schedule is safe and well tolerated by the majority of patients, but requires longer training time compared to conventional SCIg.
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Affiliation(s)
- Nina B. Hustad
- Medical Day-Unit, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Hanna M. Degerud
- Medical Day-Unit, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ingrid Hjelmerud
- Medical Day-Unit, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mai S. A. Fraz
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ingvild Nordøy
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Marius Trøseid
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Børre Fevang
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pål Aukrust
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje F. Jørgensen
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Research Institute of Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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14
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Zuppa A, De Michelis C, Meo G, Prada V, Gemelli C, Infantino M, Manfredi M, Pesce G, Tagliafico AS, Benedetti L, Fiorillo C, Schenone A, Quartuccio L, Grandis M. Maintenance treatment with subcutaneous immunoglobulins in the long-term management of anti-HMCGR myopathy. Neuromuscul Disord 2021; 31:134-138. [PMID: 33461845 DOI: 10.1016/j.nmd.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022]
Abstract
We describe the clinical response to long-term subcutaneous immunoglobulins (SCIg) in anti-3‑hydroxy-3-methyl-glutaryl-coenzyme-A-reductase (anti-HMCGR) myopathy previously treated with intravenous immunoglobulins (IVIg). We collected data from patients affected by anti-HMGCR myopathy, switched from IVIg to SCIg therapy, after achieving clinical stabilization. The Medical Research Council sum score, creatine kinase (CK) levels, and anti-HMGCR antibodies were used to assess the response. We identified three patients with anti-HMGCR myopathy treated with SCIg with a favourable clinical course, allowing the maintenance of clinical stability, the reduction or suspension of steroids therapy and in two of them a complete CK normalization. Finally, anti-HMGCR antibodies tested in all patients after 12 months from SCIg starting, showed a global decrease. SCIg represent an useful alternative to long-term IVIg as already well known in several autoimmune neuromuscular disorders and inflammatory myopathies with advantages of lower side effects and home self-administration.
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Affiliation(s)
- Angela Zuppa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Largo P. Daneo3, 16132 Genova, Italy
| | - Chiara De Michelis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Largo P. Daneo3, 16132 Genova, Italy
| | - Giuseppe Meo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Largo P. Daneo3, 16132 Genova, Italy
| | - Valeria Prada
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Largo P. Daneo3, 16132 Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Gemelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Largo P. Daneo3, 16132 Genova, Italy
| | - Maria Infantino
- Immunology and Allergy Laboratory, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Mariangela Manfredi
- Immunology and Allergy Laboratory, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Giampaola Pesce
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Autoimmunity Laboratory Department of Internal Medicine (DiMI), University of Genova, Genova, Italy
| | - Alberto S Tagliafico
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Luana Benedetti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Largo P. Daneo3, 16132 Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Fiorillo
- Department of Neuroscience, Paediatric Neurology and Neuromuscular Disorders, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Largo P. Daneo3, 16132 Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical Area (DAME), University - Hospital " Santa Maria della Misericordia", Udine, Italy
| | - Marina Grandis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Largo P. Daneo3, 16132 Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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15
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Megha KB, Mohanan PV. Role of immunoglobulin and antibodies in disease management. Int J Biol Macromol 2020; 169:28-38. [PMID: 33340621 DOI: 10.1016/j.ijbiomac.2020.12.073] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/21/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023]
Abstract
The immune system is a highly advanced and coordinated mechanism that allows a living organism to distinguish between "self" and "non-self". The host uses both innate and adaptive immune response mechanisms to identify and eliminate pathogenic microorganisms. Human immunoglobulin is the prominently used blood product in the clinical practice. Immunoglobulin applications have improved rapidly due to the exploration of its immunomodulatory and anti-inflammatory properties. This made this blood product into a precious and advanced tool in the treatment of numerous disease conditions which are linked with humoral immune deficiency or that cause immune system dysfunction. Human immunoglobulin (Ig) is used for Ig replacement therapy in both primary and secondary immunodeficiency conditions, for prevention and treatment of certain infections. It also acts as an immunomodulatory agent for autoimmune and inflammatory disorders. Therapeutic antibodies have been successfully used for the treatment of diverse pathological conditions. Drug development programs exclusively select highly specific antibodies that recognize a single disease-associated target. Hopefully this review will give an insight towards the immune system, the involvement of the specialized immune cells, their products and involvement in various immune disorders and pathological conditions.
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Affiliation(s)
- K B Megha
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695 012, Kerala, India
| | - P V Mohanan
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695 012, Kerala, India.
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16
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Abstract
Immunoglobulin replacement therapy is standard of care in treatment of many primary immunodeficiency diseases. The goal of replacement therapy is to reduce infections in individuals with primary immune deficiency and improve their quality of life. Immunoglobulin replacement therapy is most often lifelong, therefore ease of administration is vital for adherence to treatment. Self-infusion via subcutaneous intravenous immunoglobulin (SCIG) allows patient input to design an individualized and optimal treatment plan. Because SCIG regimens are flexible and allow for increased autonomy, patients receiving SCIG report improved quality of life. This article summarizes the dosing, administration, and adverse event management of SCIG infusions.
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Affiliation(s)
- Carla Duff
- Department of Allergy and Immunology, College of Medicine, College of Nursing, University of South Florida, 601 5th Street South, St Petersburg, FL 33701, USA
| | - Mark Ballow
- Division of Allergy and Immunology, Department of Pediatrics, Children's Research Institute, University of South Florida, Johns Hopkins All Children's Hospital, 140 7th Avenue South, CRI 4008, St Petersburg, FL 33701, USA.
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17
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Angelotti F, Capecchi R, Giannini D, Mazzarella O, Rocchi V, Migliorini P. Long-term efficacy, safety, and tolerability of recombinant human hyaluronidase-facilitated subcutaneous infusion of immunoglobulin (Ig) (fSCIG; HyQvia( ®)) in immunodeficiency diseases: real-life data from a monocentric experience. Clin Exp Med 2020; 20:387-392. [PMID: 32385734 DOI: 10.1007/s10238-020-00633-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
Humoral immunodeficiency diseases represent a heterogeneous group of disorders that require long-term therapies. Thus, the treatment provided must not only be effective but also safe and well tolerated. In this paper, we report our data on the efficacy, safety, and tolerability of recombinant human hyaluronidase-facilitated subcutaneous infusion of immunoglobulin (Ig) (fSCIG; HyQvia(®)) in immunodeficiency patients. We collected retrospective data from 30 patients with primary and secondary immunodeficiency diseases in therapy with fSCIG from September 2014 to December 2019. We evaluated the efficacy of the therapy, taking into account serum IgG values during follow-up and the number of annual infectious events and serious bacterial infections reported by patients. Safety was assessed on the basis of the number and intensity of adverse events (AEs) and local reactions reported. Our real-life data suggest that long-term repeated self-administration of recombinant human hyaluronidase-facilitated subcutaneous infusion of immunoglobulins results in a reduced rate of infectious events if compared to the pre-treatment rate. Both AEs and local reactions are mild to moderate and were never reasons for treatment discontinuation. Therapy with HyQvia shows prolonged efficacy and good tolerability; these aspects, together with the possibility of self-administration at home, minimize the impact the illness has on patients.
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Affiliation(s)
- Francesca Angelotti
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliera Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy
| | - Riccardo Capecchi
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliera Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy
| | - Daiana Giannini
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliera Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy
| | - Ornella Mazzarella
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliera Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy
| | - Valeria Rocchi
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliera Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy
| | - Paola Migliorini
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliera Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy.
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18
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Wasserman RL. Clinical Practice Experience with HyQvia in Adults Using Alternative Dosing Regimens and Pediatric Patients: A Retrospective Study. Adv Ther 2020; 37:1536-1549. [PMID: 32124273 PMCID: PMC7140738 DOI: 10.1007/s12325-020-01264-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Indexed: 11/03/2022]
Abstract
Introduction HyQvia (Immune Globulin Infusion 10% [Human] with Recombinant Human Hyaluronidase) was developed to combine the advantages of intravenous and subcutaneous immune globulin (SCIG), allowing administration of larger volumes at a single subcutaneous site with less frequent dosing when compared to other SCIG products. Current US prescribing guidelines for HyQvia are limited to adults and do not encompass the flexibility required to achieve success in all patients with primary immunodeficiency (PID). Methods This retrospective study was designed to evaluate the clinical experience of treating patients with PID with HyQvia regimens outside of package insert recommendations as well as in pediatric patients. Data were abstracted from 38 patient records (317 HyQvia infusions), including five patients less than 16 years of age, from seven US immunology clinics. Results Among 37 patients receiving HyQvia regimens differing from prescribing guidelines, the most notable variations included shorter ramp-up periods, use of two rather than one infusion site, and slower than maximal infusion rates to mitigate local adverse events (AEs). The medication volume infused for single site doses ranged from 75 to 200 mL and doses split between two sites ranged from 100 to 750 mL. The most common type of regimen variation was a condensed ramp-up phase (shorter schedule, higher doses), and 96% (24/25) of patients managed in this way completed ramp-up. The most common ramp-up schedule was three infusions (one at 25–45%, another at 50–75%, and the final at 100% of target dose) spread over 2–4 weeks. Conclusions A shorter ramp-up schedule did not appear to increase the number of AEs compared to standard ramp-up schedules. For patients with AEs, slower infusion rates and the use of two sites may improve medication tolerability. Four of five pediatric patients reported no AEs, and only one discontinued, stating a fear of needles. HyQvia may be tailored to adults requiring alternative rates, ramp-up, and/or dosing regimens and may be especially well-suited to children. Electronic supplementary material The online version of this article (10.1007/s12325-020-01264-7) contains supplementary material, which is available to authorized users.
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19
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Latysheva E, Rodina Y, Sizyakina L, Totolian A, Tuzankina I. Efficacy and safety of octanorm (cutaquig ®) in adults with primary immunodeficiencies with predominant antibody deficiency: a prospective, open-label study. Immunotherapy 2020; 12:299-309. [PMID: 32212944 DOI: 10.2217/imt-2020-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate efficacy and safety of octanorm (16.5% subcutaneous immunoglobulin) in adult patients with primary immunodeficiencies. Patients & methods: Primary immunodeficiencies patients (18-70 years) previously treated with intravenous immunoglobulin were included in this Phase III study. Octanorm was administered subcutaneously once weekly over 8 months. End points included infections, adverse events and quality of life. Results: 25 patients (mean age 35.2 years, female 60.0%) were recruited, 24 completed the study. Mean dose of octanorm was 0.11 g/kg/week. No serious bacterial infections occurred. Three patients (12.0%) had an adverse event (mild) assessed as related to octanorm. Both the mental and physical summary 36-item Short Form Health Survey scores were improved. Conclusion: Octanorm is effective, safe and improves quality of life. Clinical Trial registration number: NCT03988426.
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Affiliation(s)
- Elena Latysheva
- Immunopathology Department, National Research Center Institute of Immunology FMBA, 24 Kashirskoe Shosse, Moscow 115522, Russia
| | - Yulia Rodina
- Immunology Department, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology & Immunology, 1 Samory Mashela Street, Moscow 117997, Russia
| | - Liudmila Sizyakina
- Department of Clinical Immunology and Allergology, State Medical University, Rostov 344022, Russia
| | - Areg Totolian
- Laboratory of Molecular Immunology, St Petersburg Pasteur Institute, 14 Mira Street, St Petersburg 197101, Russia
| | - Irina Tuzankina
- Department of Clinical Immunology, Institute of Immunology & Physiology of the Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Street, Yekaterinburg 620049, Russia
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20
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Poskanzer SA, Thies J, Collins CJ, Myers CT, Dayuha R, Duong P, Yi F, Chang IJ, Ochs HD, Torgerson TR, Hahn SH. The co-occurrence of Wilson disease and X-linked agammaglobulinemia in one family highlights the promising diagnostic potential of proteolytic analysis. Mol Genet Genomic Med 2020; 8:e1172. [PMID: 32067425 PMCID: PMC7196455 DOI: 10.1002/mgg3.1172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We report the first case of a family with co-occurrence of Wilson disease (WD), an autosomal recessive disorder of copper metabolism, and X-linked agammaglobulinemia (XLA), a primary immunodeficiency disorder (PIDD) that features marked reduction in circulating B lymphocytes and serum immunoglobulins. METHODS AND RESULTS Through utilization of a multiplexed biomarker peptide quantification method known as the immuno-SRM assay, we were able to simultaneously and independently identify which family members are affected with WD and which are affected with XLA using dried blood spots (DBS). CONCLUSION Being able to delineate multiple diagnoses using proteolytic analysis from a single DBS provides support for implementation of this methodology for clinical diagnostic use as well as large-scale population screening, such as newborn screening (NBS). This could allow for early identification and treatment of affected individuals with WD or XLA, which have been shown to reduce morbidity and decrease mortality in these two populations.
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Affiliation(s)
- Sheri A Poskanzer
- School of Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.,Biochemical Genetics, Seattle Children's Hospital, Seattle, WA, USA
| | - Jenny Thies
- Biochemical Genetics, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Candace T Myers
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Phi Duong
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Fan Yi
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Irene J Chang
- School of Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.,Biochemical Genetics, Seattle Children's Hospital, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Hans D Ochs
- School of Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Troy R Torgerson
- School of Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Si Houn Hahn
- School of Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.,Biochemical Genetics, Seattle Children's Hospital, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
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21
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Anterasian C, Duong R, Gruenemeier P, Ernst C, Kitsen J, Geng B. Quality of Life Differences for Primary Immunodeficiency Patients on Home SCIG versus IVIG. J Clin Immunol 2019; 39:814-822. [PMID: 31673923 PMCID: PMC6863943 DOI: 10.1007/s10875-019-00705-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
Background Patients with primary immunodeficiency disease (PIDD) and antibody deficiency require lifelong immunoglobulin replacement therapy. While both subcutaneous immunoglobulin (SCIG) and intravenous immunoglobulin (IVIG) replacement therapy are effective in preventing infection, patients with PIDD still experience worse health-related quality of life (hrQOL) outcomes. Objective Assess differences in hrQOL for PIDD patients receiving home SCIG versus IVIG. Methods SF-36 surveys were administered by a specialty pharmacy to 630 PIDD patients receiving home SCIG and IVIG at baseline and then every 3 months between 2014 and 2016. Results were analyzed using two-sample t tests and linear mixed effects model. Analysis was repeated for different age categories and trended over time. Results Patients receiving SCIG reported statistically significant higher energy fatigue scores (+ 9 points, p < 0.001) but lower perceived role limitations due to physical health scores (− 14 points, p < 0.001). These differences were only observed in patients > 36 years of age. There were no differences in the composite SF-36 score for patients receiving SCIG versus IVIG (+ 1, p = 0.66). Immunoglobulin-naïve patients all improved their hrQOL, but a larger improvement was seen in those initiating SCIG versus IVIG. Conclusion Patients with PIDD on home IVIG versus SCIG have similar composite hrQOL scores as measured by the SF-36. In the adult population, initiating immunoglobulin replacement with SCIG may result in more hrQOL improvement compared with IVIG, although personal preferences should also be considered. Clinical Implications Patients with PIDD on home IVIG versus SCIG have similar composite health-related quality of life scores as measured by the SF-36. Capsule Summary Patients with primary immune-deficiency on home IVIG versus SCIG have similar composite health-related quality of life scores as measured by the SF-36. Personal preferences are important in deciding whether to treat with IVIG or SCIG. Electronic supplementary material The online version of this article (10.1007/s10875-019-00705-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christine Anterasian
- Division of Allergy/Immunology, University of California, San Diego, San Diego, CA, 92123, USA
| | - Richard Duong
- Division of Allergy/Immunology, University of California, San Diego, San Diego, CA, 92123, USA
| | | | | | - Jessica Kitsen
- Division of Allergy/Immunology, University of California, San Diego, San Diego, CA, 92123, USA
| | - Bob Geng
- Division of Allergy/Immunology, University of California, San Diego, San Diego, CA, 92123, USA.
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22
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Shrestha P, Karmacharya P, Wang Z, Donato A, Joshi AY. Impact of IVIG vs. SCIG on IgG trough level and infection incidence in primary immunodeficiency diseases: A systematic review and meta-analysis of clinical studies. World Allergy Organ J 2019; 12:100068. [PMID: 31641401 PMCID: PMC6796775 DOI: 10.1016/j.waojou.2019.100068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/27/2019] [Accepted: 08/21/2019] [Indexed: 01/10/2023] Open
Abstract
Background Monthly intravenous immunoglobulin (IVIG) and weekly subcutaneous immunoglobulin (SCIG) have been regarded as therapeutically equivalent treatments for primary immunodeficiency diseases (PIDD). Immunoglobulin G (IgG) trough level is used as a monitoring measure for infection prevention. Objective A systematic review and meta-analysis were performed to elucidate the relationship between IgG dosing, trough IgG levels with overall infection incidence in patients with PIDD receiving IVIG and SCIG therapy. Methods Medline, EMBASE, Cochrane, Central, and Scopus were searched for studies published from Jan 2010-June 2018, fulfilling the inclusion criteria. DerSimonian and Laird random-effects method were used to pool the difference of IgG trough levels. Random-effect meta-regression was used to evaluate infection incidence per 100 mg/dl IgG trough increase though IVIG and SCIG. Results Out of 24 observational studies included, 11 compared IgG trough levels among SCIG and IVIG (mean difference: 73.4 mg/dl, 95% CI: 31.67-119.19 mg/dl, I2 = 45%, p = 0.05), favoring weekly SCIG. For every 100 mg/dl increase in the trough, a linear trend of decreased incidence rates of infection was identified in SCIG patients (p = 0.03), but no similar trend was identified in trough levels vs. infection rates for patients receiving IVIG (p = 0.67). Conclusion In our study, weekly SCIG attained a higher trough level in comparison to monthly IVIG. Higher SCIG troughs were associated with lower infection rates, while IVIG troughs demonstrated no relationship.
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Affiliation(s)
- Pragya Shrestha
- Precision Population Science Lab, Asthma Epidemiology Research Unit, Department of Pediatrics and Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Reading Hospital- Tower Health System, West Reading, PA, USA
| | | | - Zhen Wang
- Mayo Clinic Evidence-based Practice Center, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Anthony Donato
- Department of Internal Medicine, Reading Hospital- Tower Health System, West Reading, PA, USA
| | - Avni Y Joshi
- Division of Pediatric and Adult Allergy/Immunology, Mayo Clinic, Rochester, MN, USA
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23
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Hill JA, Giralt S, Torgerson TR, Lazarus HM. CAR-T - and a side order of IgG, to go? - Immunoglobulin replacement in patients receiving CAR-T cell therapy. Blood Rev 2019; 38:100596. [PMID: 31416717 DOI: 10.1016/j.blre.2019.100596] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/22/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022]
Abstract
The development and regulatory approval of chimeric antigen receptor T cell (CAR-T) therapies targeting the B-lineage surface antigen CD19 represents a major milestone in cancer immunotherapy. This treatment also results in depletion of normal CD19+ B cells and is associated with hypogammaglobulinemia. These on-target, off-tumor toxicities may result in an increased risk for infection, particularly for encapsulated bacteria. Data regarding the efficacy and cost-effectiveness of prophylactic IgG replacement in CD19-targeted CAR-T cell therapy recipients is lacking, and current expert recommendations are extrapolated from the data for individuals with primary immune deficiencies. This article reviews CAR-T cell therapies targeting B-lineage lymphocytes, associated side effects, and considerations for the approach to management of hypogamaglobulinemia in this patient population. Studies are needed to establish evidence-based approaches to prophylactic immunoglobulin administration in this context, and strategies may differ by patient and CAR-T cell product characteristics.
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Affiliation(s)
- Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Troy R Torgerson
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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24
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Abbas A, Rajabally YA. Complications of Immunoglobulin Therapy and Implications for Treatment of Inflammatory Neuropathy: A Review. Curr Drug Saf 2019; 14:3-13. [PMID: 30332974 DOI: 10.2174/1574886313666181017121139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intravenous Immunoglobulin (IVIg) forms a cornerstone of effective treatment for acute and chronic inflammatory neuropathies, with a class I evidence base in Guillain-Barré Syndrome (GBS), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). It is generally considered to be a safe therapy however there are several recognised complications which are reviewed in this article. DISCUSSION AND CONCLUSION Most adverse events are immediate and mild such as headache, fever and nausea although more serious immediate reactions such as anaphylaxis may rarely occur. Delayed complications are rare but may be serious, including thromboembolic events and acute kidney injury, and these and associated risk factors are also discussed. We emphasise the importance of safe IVIg administration and highlight practical measures to minimise complications of this therapy.
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Affiliation(s)
- Ahmed Abbas
- Department of Neurophysiology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom
| | - Yusuf A Rajabally
- Department of Neurophysiology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom.,Department of Neurology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom.,Department of Aston Brain Centre, Aston University, Birmingham, United Kingdom
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25
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Viti R, Marcellusi A, Capone A, Matucci A, Vultaggio A, Pignata C, Spadaro G, Vacca A, Marasco C, Agostini C, Mennini FS. Direct and Indirect Costs of Immunoglobulin Replacement Therapy in Patients with Common Variable Immunodeficiency (CVID) and X-Linked Agammaglobulinemia (XLA) in Italy. Clin Drug Investig 2018; 38:955-965. [PMID: 30191508 DOI: 10.1007/s40261-018-0688-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Italy, there is scarce evidence on the epidemiological and economic burden induced by primary antibody deficiencies. OBJECTIVE The aim of this study was to elaborate the available epidemiological and cost data in order to estimate the annual expenditure induced by the management of patients affected by the common variable immunodeficiency (CVID) and X-linked agammaglobulinemia (XLA) requiring immunoglobulin (Ig) replacement therapy. METHODS A probabilistic cost-of-illness model was developed to estimate the number of patients with CVID and XLA, and the economic burden associated with their therapy in terms of direct or indirect costs. A systematic literature review was carried out to reveal both epidemiological and economic data. Furthermore, a probabilistic sensitivity analysis with 5000 Monte Carlo simulations was performed. RESULTS The epidemiological model allowed us to estimate the number of prevalent patients affected by XLA and CVID in Italy in 2017, corresponding to 1885 (95% confidence interval [CI] 944-3145) and 133 (95% CI 115-152) patients, respectively. The estimated total expenditure for the treatment and management of patients with CVID and XLA requiring Ig replacement therapy amounts to €42.68 million (95% CI €14.38-€86.1 million). CONCLUSIONS This information provides a comprehensive perspective of the economic issues, and facilitates better-informed public health decision making, in the management of CVID and XLA in Italy.
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Affiliation(s)
- Raffaella Viti
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.
- Institute for Leadership and Management in Health, Kingston University London, London, UK.
| | - Alessandro Capone
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - Andrea Matucci
- Immunoallergology Unit, AOU Careggi, University of Florence, Florence, Italy
| | | | - Claudio Pignata
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Carolina Marasco
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Carlo Agostini
- Department of Medicine (DIMED), Internal Medicine 1, Treviso Ca' Foncello Hospital, University of Padua, Padua, Italy
| | - Francesco Saverio Mennini
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
- Institute for Leadership and Management in Health, Kingston University London, London, UK
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26
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Cherin P, Tadmouri A, de Jaeger C, Pindi Sala T, Crave JC. Assessment of renal function in patients with myositis and treated with subcutaneous immunoglobulin: a series of 24 cases. Ther Adv Musculoskelet Dis 2018; 10:201-207. [PMID: 30327686 DOI: 10.1177/1759720x18787765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/15/2018] [Indexed: 11/16/2022] Open
Abstract
Immunoglobulin (Ig) therapy is used to treat a wide range of immunodeficiencies and autoimmune diseases; While, its clinical benefit has been demonstrated in several studies, Ig therapy is associated with a risk of systemic adverse effects. As such, Onset of renal impairment, including acute renal failure, osmotic nephrosis and renal insufficiency, after immunoglobulin administration is rare, but is one of the most significant concerns related to intravenous Ig use at immunomodulatory doses. However, only few studies have investigated the safety of subcutaneous Ig (SCIg) in relation to these rare conditions. The aim of this prospective study is to describe the safety of SCIg (Gammanorm), specifically with regards to renal function, in inflammatory myopathies including mainly polymyositis (PM), dermatomyositis (DM) and inclusion body myositis (IBM). Twenty-four cases were included: 10 patients with PM, 6 with IBM, 5 with DM, 2 with mixed connective-tissue disease (MCTD) and 1 patient with scleromyositis. SCIg was given two to three times per week at 2 g/kg/month in all patients. Patients were treated for a mean duration of 24.6 ± 11.4 months (range 8-37 months) and received a median of 78 SCIg infusions. Renal function was stable over the study period in all patients. High-dose SCIg was well tolerated; the treatment was not withdrawn during the first year in any patient for safety issues. These results suggest that the use of high-dose SCIg is generally feasible and safe in patients with inflammatory myopathies.
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Affiliation(s)
- Patrick Cherin
- Department of Internal Medicine, Pitié-Salpetrière Hospital Group, 47-83 Boulevard de l'hôpital, 75013, Paris, France
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27
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Berger M, Harbo T, Cornblath DR, Mielke O. IgPro20, the Polyneuropathy and Treatment with Hizentra® study (PATH), and the treatment of chronic inflammatory demyelinating polyradiculoneuropathy with subcutaneous IgG. Immunotherapy 2018; 10:919-933. [DOI: 10.2217/imt-2018-0036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Subcutaneous IgG (SCIG) administration may be preferred over the intravenous route (IVIG) in chronic inflammatory demyelinating polyneuropathy (CIDP) because it minimizes ‘end of cycle’ treatment-related fluctuations, reduces systemic adverse effects, improves convenience/quality of life and potentially lowers overall costs. Early reports of the use of highly concentrated SCIG preparations suggested they were effective and well-tolerated in chronic inflammatory demyelinating polyneuropathy. This was confirmed in the Polyneuropathy and Treatment with Hizentra® study of 172 subjects randomized to receive maintenance therapy with placebo or one of two doses of IgPro20 (20% IgG stabilized with L-Proline) for 6 months. Risk of relapse was reduced by SCIG in a dose-related manner as compared with placebo. A total of 88% of polyneuropathy and treatment with hizentra subjects felt the subcutaneous method was ‘easy to learn’. Local adverse events were mostly mild or moderate, and systemic adverse events were infrequent. Some patients may prefer maintenance therapy with SCIG over IVIG.
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Affiliation(s)
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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28
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Biweekly Hizentra® in Primary Immunodeficiency: a Multicenter, Observational Cohort Study (IBIS). J Clin Immunol 2018; 38:602-609. [PMID: 29951948 PMCID: PMC6061090 DOI: 10.1007/s10875-018-0528-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/19/2018] [Indexed: 12/29/2022]
Abstract
Immunoglobulin G (IgG) replacement therapy is a standard treatment for patients with primary immunodeficiency diseases (PIDs). Hizentra®, a 20% human subcutaneous IgG (SCIG), is approved for biweekly administration for PIDs. The aim of the multicenter IBIS study was to prospectively investigate the efficacy of biweekly Hizentra® compared with previous IVIG or SCIG treatment regimens in patients with PIDs. The study consisted of a 12-month retrospective period followed by 12-month prospective observational period. The main endpoints included pre-infusion IgG concentrations, proportion of patients with serious bacterial infections (SBIs), other infections, hospitalizations due to PID-related illnesses, and days with antibiotics during the study periods. Of the 36 patients enrolled in the study, 35 patients continued the study (mean age 26.1 ± 14.4 years; 68.6% male). The mean pre-infusion IgG levels for prior immunoglobulin regimens during the retrospective period (7.84 ± 2.09 g/L) and the prospective period (8.55 ± 1.76 g/L) did not show any significant variations (p = 0.4964). The mean annual rate of SBIs/patient was 0.063 ± 0.246 for both prospective and retrospective periods. No hospitalizations related to PIDs were reported during the prospective period versus one in the retrospective period. All patients were either very (76.5%) or quite (23.5%) satisfied with biweekly Hizentra® at the end of the study. In conclusion, the IBIS study provided real-world evidence on the efficacy of biweekly Hizentra® in patients with PIDs, thus verifying the data generated by the pharmacometric modeling and simulation study in a normal clinical setting.
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29
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Allen JA, Berger M, Querol L, Kuitwaard K, Hadden RD. Individualized immunoglobulin therapy in chronic immune-mediated peripheral neuropathies. J Peripher Nerv Syst 2018; 23:78-87. [PMID: 29573033 PMCID: PMC6033159 DOI: 10.1111/jns.12262] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022]
Abstract
Despite the well-recognized importance of immunoglobulin therapy individualization during the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP), the pathway to best achieve optimization is unknown. There are many pharmacokinetic and immunobiologic variables that can potentially influence the appropriateness of any individual therapy. Although identification of specific autoantibodies and their targets has only been accomplished in a minority of patients with CIDP, already the diagnostic and treatment implications of specific autoantibody detection are being realized. Individual variability in IgG pharmacokinetic properties including IgG catabolic rates and distribution, as well as the IgG level necessary for disease control also require consideration during the optimization process. For optimization to be successful there must be a measure of treatment response that has a clinically meaningful interpretation. There are currently available well-defined and validated clinical assessment tools and outcome measures that are well suited for this purpose. While there remains much to learn on how best to manipulate immunopathology and immunoglobulin pharmacokinetics in the most favorable way, there currently exists an understanding of these principles to a degree sufficient to begin to develop rational and evidence-based treatment optimization strategies.
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Affiliation(s)
- Jeffrey A Allen
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Melvin Berger
- Immunology Research and Development, CSL Behring, King of Prussia, PA, USA
| | - Luis Querol
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Krista Kuitwaard
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Robert D Hadden
- Department of Neurology, King's College Hospital, London, UK
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30
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Ueda M, Berger M, Gale RP, Lazarus HM. Immunoglobulin therapy in hematologic neoplasms and after hematopoietic cell transplantation. Blood Rev 2018; 32:106-115. [DOI: 10.1016/j.blre.2017.09.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/28/2017] [Accepted: 09/15/2017] [Indexed: 12/27/2022]
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31
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Goudouris ES, Rego Silva AMD, Ouricuri AL, Grumach AS, Condino-Neto A, Costa-Carvalho BT, Prando CC, Kokron CM, Vasconcelos DDM, Tavares FS, Silva Segundo GR, Barreto IC, Dorna MDB, Barros MA, Forte WCN. II Brazilian Consensus on the use of human immunoglobulin in patients with primary immunodeficiencies. EINSTEIN-SAO PAULO 2017; 15:1-16. [PMID: 28444082 PMCID: PMC5433300 DOI: 10.1590/s1679-45082017ae3844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/04/2017] [Indexed: 12/18/2022] Open
Abstract
In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new knowledge about the indications and efficacy of immunoglobulin therapy in primary immunodeficiencies, relevant production-related aspects, mode of use (routes of administration, pharmacokinetics, doses and intervals), adverse events (major, prevention, treatment and reporting), patient monitoring, presentations available and how to have access to this therapeutic resource in Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | - Cristina Maria Kokron
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Mayra de Barros Dorna
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Myrthes Anna Barros
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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32
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Kuitwaard K, Fokkink WJR, Brusse E, Vrancken AFJE, Eftimov F, Notermans NC, van der Kooi AJ, Merkies ISJ, Jacobs BC, van Doorn PA. Maintenance IV immunoglobulin treatment in chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2017; 22:425-432. [PMID: 29092099 DOI: 10.1111/jns.12242] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 12/27/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients treated with intravenous immunoglobulin (IVIg) usually start with a standard dosage of 2 g/kg bodyweight. Only a minority of patients has a sustained improvement, and most require ongoing maintenance treatment. Preferred IVIg regimens, however, vary considerably between doctors and at present it is unknown which is optimal. As there are also large differences in IVIg dosage and interval requirements between patients, optimal IVIg maintenance treatment of CIDP is even more complex. The lack of evidence-based guidelines on how IVIg maintenance treatment should be administered may potentially lead to under- or overtreatment of this expensive therapy. We provide an overview of published practical IVIg maintenance treatment regimens, IVIg maintenance schedules used in randomized controlled trials and one based upon our own long-term experience on how this treatment could be given in CIDP.
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Affiliation(s)
- Krista Kuitwaard
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Willem-Jan R Fokkink
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alexander F J E Vrancken
- Department of Neurology, Brain Center Rudolf Magnus University, Medical Center Utrecht, Utrecht, The Netherlands
| | - Filip Eftimov
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicolette C Notermans
- Department of Neurology, Brain Center Rudolf Magnus University, Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ingemar S J Merkies
- Department of Neurology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurology, St. Elisabeth Hospital, Willemstad, Curacao
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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33
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Kuitwaard K, Fokkink WJR, Brusse E, Vrancken AFJE, Eftimov F, Notermans NC, van der Kooi AJ, Merkies ISJ, Jacobs BC, van Doorn PA. Protocol of a dose response trial of IV immunoglobulin in chronic inflammatory demyelinating polyradiculoneuropathy (DRIP study). J Peripher Nerv Syst 2017; 23:5-10. [PMID: 29119642 DOI: 10.1111/jns.12244] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/03/2017] [Indexed: 11/30/2022]
Abstract
High peak levels of serum IgG may not be needed for maintenance treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with intravenous immunoglobulin (IVIg). More frequent dosing of IVIg leads to more stable IgG levels and higher trough levels which may be related with improved clinical efficacy. More frequent lower dosing leads to lower peak levels and may induce less systemic side-effects. The DRIP study is a double-blind randomized controlled cross-over intervention study. CIDP patients ≥18 years old, proven IVIg dependent and receiving an individually established but stable maintenance dose and interval of IVIg (Kiovig) can be included. One group (A) will be treated with their normal dosage and interval of IVIg and receive a placebo (albumin 0.5%) infusion in between their regular IVIg infusions, for a total of four infusions. The other group (B) will be treated with half their normal IVIg dosage (with the same volume of placebo to maintain the total volume) at half their interval (double their frequency) for four infusions. After a wash-out phase (2 infusions), patients will cross-over to the other treatment group. During the study the total dose of IVIg administered will remain unchanged as before start of the trial. The main objective is to investigate whether high frequent low dosage IVIg treatment is more effective than low frequent high dosage IVIg treatment as maintenance treatment for CIDP. Hand grip strength, as measured by the Martin Vigorimeter, will be used as the primary outcome measure. Secondary objective is to investigate whether high frequent low dosage of IVIg results in less adverse events compared to low frequent high dosage treatment. The DRIP study is currently ongoing and the protocol is presented.
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Affiliation(s)
- Krista Kuitwaard
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Willem-Jan R Fokkink
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Alexander F J E Vrancken
- Department of Neurology, Brain Center Rudolf Magnus University Medical Center Utrecht, Utrecht, The Netherlands
| | - Filip Eftimov
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicolette C Notermans
- Department of Neurology, Brain Center Rudolf Magnus University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ingemar S J Merkies
- Department of Neurology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurology, St. Elisabeth Hospital, Willemstad, Curaçao
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Garnero M, Fabbri S, Gemelli C, Benedetti L, Mancardi GL, Schenone A, Grandis M. Subcutaneous Immunoglobulins are a Valuable Treatment Option in Myasthenia Gravis. J Clin Neurol 2017; 14:98-99. [PMID: 29141277 PMCID: PMC5765263 DOI: 10.3988/jcn.2018.14.1.98] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/12/2017] [Accepted: 06/16/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Martina Garnero
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genova, Genova, Italy.
| | - Sabrina Fabbri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genova, Genova, Italy
| | - Chiara Gemelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genova, Genova, Italy
| | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genova, Genova, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genova, Genova, Italy
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genova, Genova, Italy
| | - Marina Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genova, Genova, Italy
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Quality of Life, Treatment Beliefs, and Treatment Satisfaction in Children Treated for Primary Immunodeficiency with SCIg. J Clin Immunol 2017; 37:496-504. [PMID: 28597145 DOI: 10.1007/s10875-017-0409-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 12/13/2022]
Abstract
Despite the development of subcutaneous treatment, children and adolescents with primary immunodeficiency (PID) are vulnerable to a lower quality of life (QoL) than non-clinical participants. Comparisons have been offered in rare reports with limited sample sizes. No description is available of treatment beliefs and treatment satisfaction with standard tools. The objective of this study was to describe a large sample of patients with pediatric PID on QoL, treatment beliefs and satisfaction, and identify perceived benefits and issues of treatment both in children and parents. A mail-back survey was conducted in 60 patients with PID treated with subcutaneous Ig and their parents from a clinic in Montreal (QC, Canada). We used the standardized tools to assess for QoL levels, beliefs of necessity and concerns with treatment, and dimensions of satisfaction. We collected and coded perceived benefits and issues through open-ended questions. We found lower QoL in children with PID than in healthy non-clinical participants (median d = 0.40) and similar QoL levels to children with cancer (median d = 0.12). Participants considered their treatment as less necessary and able to control the illness and less convenient than patients with other conditions. Children were more prone to consider the treatment as convenient (69 vs. 47% p = .028) but reported more discomfort (24 vs. 10% p = .043) than parents. Results suggest a lower-than-expected QoL in pediatric PID. Aspects of the illness and treatment are probably unclear to patients and their families, as necessity beliefs were lower than expected. Educational strategies should be developed and assessed to address this issue.
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Al-Ahmad M, Maher A, Nurkic J. Health-related quality of life in patients with common variable immunodeficiency switching from intravenous to subcutaneous immunoglobulin therapy. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2017. [DOI: 10.4103/ejim.ejim_2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pasquet M, Pellier I, Aladjidi N, Auvrignon A, Cherin P, Clerson P, Cozon GJN, Jaussaud R, Bienvenu B, Hoarau C. A cohort of French pediatric patients with primary immunodeficiencies: are patient preferences regarding replacement immunotherapy fulfilled in real-life conditions? Patient Prefer Adherence 2017; 11:1171-1180. [PMID: 28744107 PMCID: PMC5513882 DOI: 10.2147/ppa.s123363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess quality of life and satisfaction regarding immunoglobulin-replacement therapy (IgRT) treatment according to the route (intravenous Ig [IVIg] or subcutaneous Ig [SCIg]) and place of administration (home-based IgRT or hospital-based IgRT). SUBJECTS AND METHODS Children 5-15 years old treated for primary immunodeficiency disease (PIDD) with IgRT for ≥3 months were included in a prospective, noninterventional cohort study and followed over 12 months. Quality of life was assessed with the Child Health Questionnaire - parent form (CHQ-PF)-50 questionnaire. Satisfaction with IgRT was measured with a three-dimensional scale (Life Quality Index [LQI] with three components: factor I [FI], treatment interference; FII, therapy-related problems; FIII, therapy settings). RESULTS A total of 44 children (9.7±3.2 years old) receiving IgRT for a mean of 5.6±4.5 years (median 4.1 years) entered the study: 18 (40.9%) were receiving hospital-based IVIg, two (4.6%) were receiving home-based IVIg, and 24 (54.6%) were treated by home-based SCIg. LQI FIII was higher for home-based SCIg than for hospital-based IVIg (P=0.0003), but there was no difference for LQI FI or LQI FII. LQI FIII significantly improved in five patients who switched from IVIg to SCIg during the follow-up when compared to patients who pursued the same regimen (either IVIg or SCIg). No difference was found on CHQ-PF50 subscales, LQI FI, or LQI FII. CONCLUSION Home-based SCIg gave higher satisfaction regarding therapy settings than hospital-based IVIg. No difference was found on other subscales of the LQI or CHQ-PF50 between hospital-based IVIG and home-based SCIG.
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Affiliation(s)
- Marlène Pasquet
- Pediatric Hematology and Oncology Department, University Hospital Centre of Toulouse, Toulouse
- Correspondence: Marlène Pasquet, Pediatric Hematology and Oncology Department, University Hospital Centre of Toulouse, 330 Avenue de la Grande Bretagne, Toulouse 31059, France, Tel +33 5 3455 8643, Fax +33 5 3455 8612, Email
| | | | - Nathalie Aladjidi
- Paediatric Hematology Unit, CEREVANCE, CIC 1401, Inserm CICP, Hospital Pellegrin
| | | | | | | | | | - Roland Jaussaud
- Internal Medicine and Clinical Immunology Department, University Hospital Centre of Nancy, Nancy
| | - Boris Bienvenu
- Internal Medicine Department, University Hospital Centre of Caen, Caen
| | - Cyrille Hoarau
- Renal Transplantation and Clinical immunology Department, University Hospital Centre of Tours, Tours, France
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Perez EE, Orange JS, Bonilla F, Chinen J, Chinn IK, Dorsey M, El-Gamal Y, Harville TO, Hossny E, Mazer B, Nelson R, Secord E, Jordan SC, Stiehm ER, Vo AA, Ballow M. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol 2016; 139:S1-S46. [PMID: 28041678 DOI: 10.1016/j.jaci.2016.09.023] [Citation(s) in RCA: 391] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 09/12/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
Abstract
Human immunoglobulin preparations for intravenous or subcutaneous administration are the cornerstone of treatment in patients with primary immunodeficiency diseases affecting the humoral immune system. Intravenous preparations have a number of important uses in the treatment of other diseases in humans as well, some for which acceptable treatment alternatives do not exist. We provide an update of the evidence-based guideline on immunoglobulin therapy, last published in 2006. Given the potential risks and inherent scarcity of human immunoglobulin, careful consideration of its indications and administration is warranted.
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Affiliation(s)
- Elena E Perez
- Allergy Associates of the Palm Beaches, North Palm Beach, Fla.
| | - Jordan S Orange
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Francisco Bonilla
- Department of Pediatrics, Clinical Immunology Program, Children's Hospital Boston and Harvard Medical School, Boston, Mass
| | - Javier Chinen
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Ivan K Chinn
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Morna Dorsey
- Department of Pediatrics, Allergy, Immunology and BMT Division, Benioff Children's Hospital and University of California, San Francisco, Calif
| | - Yehia El-Gamal
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Terry O Harville
- Departments of Pathology and Laboratory Services and Pediatrics, University of Arkansas, Little Rock, Ark
| | - Elham Hossny
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Bruce Mazer
- Department of Pediatrics, Allergy and Immunology, Montreal Children's Hospital and McGill University, Montreal, Quebec, Canada
| | - Robert Nelson
- Department of Medicine and Pediatrics, Division of Hematology and Oncology and Stem Cell Transplantation, Riley Hospital, Indiana University School of Medicine and the IU Melvin and Bren Simon Cancer Center, Indianapolis, Ind
| | - Elizabeth Secord
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, Mich
| | - Stanley C Jordan
- Nephrology & Transplant Immunology, Kidney Transplant Program, David Geffen School of Medicine at UCLA and Cedars-Sinai Medical Center, Los Angeles, Calif
| | - E Richard Stiehm
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | - Ashley A Vo
- Transplant Immunotherapy Program, Comprehensive Transplant Center, Kidney Transplant Program, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Mark Ballow
- Department of Pediatrics, Division of Allergy & Immunology, University of South Florida, Morsani College of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla
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Debs R, Reach P, Cret C, Demeret S, Saheb S, Maisonobe T, Viala K. A new treatment regimen with high-dose and fractioned immunoglobulin in a special subgroup of severe and dependent CIDP patients. Int J Neurosci 2016; 127:864-872. [PMID: 27918219 DOI: 10.1080/00207454.2016.1269328] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic inflammatory demyelinating polyneuropathy (CIDP) is treated with intravenous immunoglobulins (IVIg), corticosteroids or plasma exchange (PE). IVIg dosage is not universal and markers for treatment management are needed. METHODS We report the response to high-dose and fractioned IVIg in a subgroup of definite CIDP patients, resistant to corticosteroids and PE, responders to IVIg but with an efficacy window <15 d. RESULTS Four patients were included with similar predominantly clinical motor form and conduction abnormalities. Treatment management consisted of fractioning IVIg and increasing the monthly cumulated dose (mean: 3 g/kg/month). Serum IgG concentration was measured and correlated to the clinical state. Monitoring of serum IgG helped to guide IVIg administration dosage and frequency. A mean of 10 months was required to improve symptoms; therapy was then switched to subcutaneous (SC) route (maintenance dose: 3.5 g/kg/month). The mean Overall Neuropathy Limitations Scale was improved from 11 to 3.2 and the mean Medical Research Council scale from 26 to 90. CONCLUSION It is important to distinguish patients with short IVIg efficacy window from those with classical resistance since the former may benefit from fractioning and increasing the IVIg dose. The monitoring of serum IgG level and its correlation to the clinical response could be of help in monitoring each individual's dosage.
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Affiliation(s)
- Rabab Debs
- a Département de Neurophysiologie , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France.,c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
| | - Pauline Reach
- a Département de Neurophysiologie , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France.,c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
| | - Corina Cret
- b Neurology Department , Centre Hospitalier de Meaux , Meaux , France
| | - Sophie Demeret
- c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
| | - Samir Saheb
- d Centre Clinique d'Hémobiothérapie, service d'Hématologie , Groupe Hospitalier Pitié-Salpêtrière , AP-HP , Paris , France
| | - Thierry Maisonobe
- a Département de Neurophysiologie , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France.,c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
| | - Karine Viala
- a Département de Neurophysiologie , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France.,c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
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Canessa C, Iacopelli J, Pecoraro A, Spadaro G, Matucci A, Milito C, Vultaggio A, Agostini C, Cinetto F, Danieli MG, Gambini S, Marasco C, Trizzino A, Vacca A, De Mattia D, Martire B, Plebani A, Di Gioacchino M, Gatta A, Finocchi A, Licciardi F, Martino S, De Carli M, Moschese V, Azzari C. Shift from intravenous or 16% subcutaneous replacement therapy to 20% subcutaneous immunoglobulin in patients with primary antibody deficiencies. Int J Immunopathol Pharmacol 2016; 30:73-82. [PMID: 27927705 PMCID: PMC5806788 DOI: 10.1177/0394632016681577] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In patients with primary antibody deficiencies, subcutaneous administration of IgG (SCIG) replacement is effective, safe, well-tolerated, and can be self-administered at home. A new SCIG replacement at 20% concentration (Hizentra®) has been developed and has replaced Vivaglobin® (SCIG 16%). An observational prospective multi-centric open-label study, with retrospective comparison was conducted in 15 Italian centers, in order to investigate whether and to what extent switching to Hizentra® would affect frequency of infusions, number of infusion sites, patients’ satisfaction, and tolerability in patients previously treated with Vivaglobin® or intravenous immunoglobulins (IVIG). Any variations of dosage, frequency and duration of the infusions, and of number of infusion sites induced by Hizentra® with respect to the former treatment were recorded. Practical advantages and disadvantages of Hizentra®, with respect to the medicinal product formerly used, and the variations in patients’ therapy-related satisfaction were monitored by means of the TSQM (Treatment Satisfaction Questionnaire for Medication); number, frequency, and duration of infectious events and adverse effects were recorded. Eighty-two patients switched to Hizentra®: 19 (23.2%) from IVIG and 63 (76.8%) from Vivaglobin®. The mean interval between infusions was not affected by the shift (7.0 ± 2.0 days with previous treatment versus 7.1 ± 1.2 during Hizentra®). A decrease in the number of infusion sites with Hizentra® was recorded in 12 out of 56 patients for whom these data were available. At 6 months, 89.7% of patients were satisfied with Hizentra®; no difference in terms of effectiveness, side effects, convenience, and global satisfaction was observed. No difference in the incidence of adverse events was reported.
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Affiliation(s)
- Clementina Canessa
- 1 Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Jessica Iacopelli
- 1 Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Antonio Pecoraro
- 2 Department of Translational Medical Sciences, Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Spadaro
- 2 Department of Translational Medical Sciences, Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | | | - Cinzia Milito
- 4 Molecular Medicine Department, Sapienza University of Rome, Rome, Italy
| | | | - Carlo Agostini
- 5 Department of Medicine DIMED, Clinical Immunology, Padova University, Padova, Italy
| | - Francesco Cinetto
- 5 Department of Medicine DIMED, Clinical Immunology, Padova University, Padova, Italy
| | | | | | - Carolina Marasco
- 7 Department of Biomedical Sciences and Human Oncology, Clinica Medica "G. Baccelli", University of Bari Medical School, Bari, Italy
| | - Antonino Trizzino
- 8 Department of Pediatric Hematology and Oncology, ARNAS Civico, Palermo, Italy
| | - Angelo Vacca
- 7 Department of Biomedical Sciences and Human Oncology, Clinica Medica "G. Baccelli", University of Bari Medical School, Bari, Italy
| | - Domenico De Mattia
- 9 Neonatology and NICU, Department of Biochemical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Baldassarre Martire
- 10 Department of Pediatric Science and Surgery, Pediatric Hospital "Policlinico-Giovanni XXIII", Bari, Italy
| | - Alessandro Plebani
- 11 Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Mario Di Gioacchino
- 12 Department of Medicine and Science of Ageing, "G. d'Annunzio" University, Chieti, Italy
| | - Alessia Gatta
- 12 Department of Medicine and Science of Ageing, "G. d'Annunzio" University, Chieti, Italy
| | - Andrea Finocchi
- 13 Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy.,14 Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Licciardi
- 15 SCDU Pediatria II, Immunoreumatologia, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Silvana Martino
- 15 SCDU Pediatria II, Immunoreumatologia, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco De Carli
- 16 Dipartimento di Medicina Interna, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Viviana Moschese
- 17 Department of Pediatrics, "Tor Vergata" University, Policlinico "Tor Vergata", Rome, Italy
| | - Chiara Azzari
- 1 Anna Meyer Children's Hospital, University of Florence, Florence, Italy
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Practical Considerations for Self-Administration of Subcutaneous Immunoglobulin G Utilizing Recombinant Human Hyaluronidase, an Advanced Method of Subcutaneous Administration: A Nurse's Perspective. JOURNAL OF INFUSION NURSING 2016; 39:359-368. [PMID: 27828933 DOI: 10.1097/nan.0000000000000182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An approved subcutaneous infusion of immunoglobulin G using recombinant human hyaluronidase (IGHy) allows adult patients with primary immunodeficiency disease to self-administer every 3 to 4 weeks using 1 to 2 subcutaneous infusion site(s). This article reviews the practical considerations for nurses to simplify patient education and training. Key considerations include pump choice and parameters, ancillary supplies, and technique. Patient education includes infusion log upkeep and management of potential reactions. Educational initiatives should be designed to meet specific patient needs. Successful IGHy self-administration depends on proper patient training and continuing interaction between the health care team and the patient to optimize the patient experience.
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Bourque PR, Pringle CE, Cameron W, Cowan J, Chardon JW. Subcutaneous Immunoglobulin Therapy in the Chronic Management of Myasthenia Gravis: A Retrospective Cohort Study. PLoS One 2016; 11:e0159993. [PMID: 27490101 PMCID: PMC4973986 DOI: 10.1371/journal.pone.0159993] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immunoglobulin therapy has become a major treatment option in several autoimmune neuromuscular disorders. For patients with Myasthenia Gravis (MG), intravenous immunoglobulin (IVIg) has been used for both crisis and chronic management. Subcutaneous Immunoglobulins (SCIg), which offer the advantage of home administration, may be a practical and effective option in chronic management of MG. We analyzed clinical outcomes and patient satisfaction in nine cases of chronic disabling MG who were either transitioned to, or started de novo on SCIg. METHODS AND FINDINGS This was a retrospective cohort study for the period of 2015-2016, with a mean follow-up period of 6.8 months after initiation of SCIg. All patients with MG treated with SCIg at the Ottawa Hospital, a large Canadian tertiary hospital with subspecialty expertise in neuromuscular disorders were included, regardless of MG severity, clinical subtype and antibody status. The primary outcome was MG disease activity after SCIg initiation. This outcome was measured by 1) the Myasthenia Gravis Foundation of America (MGFA) clinical classification, and 2) subjective scales of disease activity including the Myasthenia Gravis activities of daily living profile (MG-ADL), Myasthenia Gravis Quality-of-life (MG-QOL 15), Visual Analog (VA) satisfaction scale. We also assessed any requirement for emergency department visits or hospitalizations. Safety outcomes included any SCIg related complication. All patients were stable or improved for MGFA class after SCIg initiation. Statistically significant improvements were documented in the MG-ADL, MG-QOL and VAS scales. There were no exacerbations after switching therapy and no severe SCIg related complications. CONCLUSIONS SCIg may be a beneficial therapy in the chronic management of MG, with favorable clinical outcome and patient satisfaction results.
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Affiliation(s)
- P. R. Bourque
- The Ottawa Hospital, Department of Medicine, Division of Neurology, Ottawa, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
- * E-mail:
| | - C. E. Pringle
- The Ottawa Hospital, Department of Medicine, Division of Neurology, Ottawa, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
| | - W. Cameron
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
- The Ottawa Hospital, Department of Medicine, Division of Infectious Diseases, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - J. Cowan
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
- The Ottawa Hospital, Department of Medicine, Division of Infectious Diseases, Ottawa, Canada
| | - J. Warman Chardon
- The Ottawa Hospital, Department of Medicine, Division of Neurology, Ottawa, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
- Children’s Hospital of Eastern Ontario, Division of Genetics, Ottawa, Canada
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43
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Wasserman RL, Melamed I, Stein MR, Engl W, Sharkhawy M, Leibl H, Puck J, Rubinstein A, Kobrynski L, Gupta S, Grant AJ, Ratnayake A, Richmond WG, Church J, Yel L, Gelmont D. Long-Term Tolerability, Safety, and Efficacy of Recombinant Human Hyaluronidase-Facilitated Subcutaneous Infusion of Human Immunoglobulin for Primary Immunodeficiency. J Clin Immunol 2016; 36:571-82. [PMID: 27220317 PMCID: PMC4940441 DOI: 10.1007/s10875-016-0298-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/11/2016] [Indexed: 11/27/2022]
Abstract
Purpose Treatment of primary immunodeficiency diseases (PIDD) with subcutaneous (SC) infusions of IgG preceded by injection of recombinant human hyaluronidase (rHuPH20) (IGHy) to increase SC tissue permeability was evaluated in two consecutive, prospective, non-controlled, multi-center studies. Methods Subjects >4 years of age received SC IgG replacement at a weekly dose equivalent of 108 % of their previous intravenous (IV) dose, facilitated by prior injection of 75 U/g IgG of rHuPH20. Starting with weekly SC infusions, the interval was increased (ramped-up) to a 3- or 4-week schedule. Results Eighty-three subjects (24 < 18 years; 59 ≥ 18 years) received 2729 infusions (excluding ramp-up) at a mean dose of 0.155 g/kg/week in the pivotal and 0.156 g/kg/week in the extension study. IGHy exposure exceeded 30 months in 48 subjects. During 187.7 subject-years of IGHy exposure, 2005 adverse events (AEs) (10.68 per subject-year) occurred. The rate of related systemic AEs during consecutive 1-year periods remained low; the rate of related local AEs decreased from 3.68/subject-year in months 1–12 to approximately 1.50/subject-year after 30 months of treatment. Fifteen subjects transiently developed anti-rHuPH20 binding antibody. There was no difference in AE rates in these subjects before and after the first titer increase to ≥1:160. The rate of infections during IGHy exposure was 2.99 per subject-year and did not increase during the studies. Annual infection rates were 3.02 in subjects <18 years and 2.98 in subjects ≥18 years. Conclusions Long-term replacement therapy with IGHy was safe and effective in 83 pediatric and adult subjects with PIDD. Electronic supplementary material The online version of this article (doi:10.1007/s10875-016-0298-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Isaac Melamed
- IMMUNOe Clinical Research Center, Centennial, CO, USA
| | - Mark R Stein
- Allergy Associates of the Palm Beaches, North Palm Beach, FL, USA
| | | | | | | | - Jennifer Puck
- University of California San Francisco, San Francisco, CA, USA
| | - Arye Rubinstein
- Allergy & Immunology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Lisa Kobrynski
- Emory Children's Center, Emory University, Atlanta, GA, USA
| | | | | | | | | | - Joseph Church
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - David Gelmont
- Baxalta US Inc., Westlake Village, CA, 91362-3811, USA.
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Shabaninejad H, Asgharzadeh A, Rezaei N, Rezapoor A. A Comparative Study of Intravenous Immunoglobulin and Subcutaneous Immunoglobulin in Adult Patients with Primary Immunodeficiency Diseases: A Systematic Review and Meta-Analysis. Expert Rev Clin Immunol 2016; 12:595-602. [PMID: 26902306 DOI: 10.1586/1744666x.2016.1155452] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Subcutaneous immunoglobulin (SCIG) is a new therapeutic procedure for patients with primary immunodeficiency (PI). This research is a systematic review of studies on the efficacy and safety of intravenous immunoglobulin (IVIG) and SCIG in adult patients with PI. This study includes a systematic review of cohorts and randomized clinical trials (24 articles) from 5 databases with no time limits. Random effects meta-analysis was performed for outcomes such as efficacy and safety. Standard mean difference (SMD) of serum immunoglobulin level was equal to 0.336 (P <0.01; 0.205-0.467) and the odds ratio (OR) of side effects was 0.497 (P=0.1; 0.180-1.371). The results indicate that SCIG leads to a higher level of immunoglobulin and a reduction in side effects but shows the same infection rate as IVIG. Our analysis shows that shifting from IVIG to SCIG therapy can have clinical benefits for PI patients.
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Affiliation(s)
- Hosein Shabaninejad
- a Department of Health Management, School of Health Management & Information Sciences , Iran University of Medical Sciences , Tehran , Iran
| | - Asra Asgharzadeh
- b School of Health Management & Information Sciences , Iran University of Medical Sciences , Tehran , Iran
| | - Nima Rezaei
- c Research Center for Immunodeficiencies, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Aziz Rezapoor
- d Health management and economics research center , Iran University of Medical Sciences , Tehran , Iran
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Aydıner EK, Kıykım A, Barış S, Özen A, Barlan I. Use of subcutaneous immunoglobulin in primary immune deficiencies. TURK PEDIATRI ARSIVI 2016; 51:8-14. [PMID: 27103859 PMCID: PMC4829171 DOI: 10.5152/turkpediatriars.2016.3058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022]
Abstract
AIM Immunoglobulin replacement therapy is required to reduce the frequency and severity of infections in patients with primary antibody deficiencies. Immunoglobulin G (IgG) can be administered intramuscularly, intravenously or subcutaneously. We aimed to evaluate the efficacy, dose adjustment and adverse events in subcutaneous immunoglobulin therapy by retrospectively presenting the records of 16 patients who received subcutaneous immunoglobulin therapy. MATERIAL AND METHODS The demographic findings, clinical and laboratory findings, subcutaneous immunoglobulin dosage and dose frequency, infusion time, area and methods, adverse events and frequency of infections were obtained from patient files and recorded. RESULTS Sixteen patients (seven female, nine male) aged between 0-33 years who were diagnosed with primary immune deficiency and treated with subcutaneous immunoglobulin were enrolled. All patients had been receiving intravenous imunoglobulin (5-10%) at a dose of 0.33-1.25 gr/kg/dose with two-four week intervals before subcutaneous immunoglobulin. Subcutaneous immunoglobulin (10%) was administered at a dose of 0.03-0.43 gr/kg/dose with one-two week intervals. No significant difference was found between serum through IgG levels before administration of intravenous imunoglobulin and steady state IgG levels during subcutaneous immunoglobulin therapy. When five patients whose serum through IgG levels were below 600 mg/dL were evaluated, however, a significant increase was found in steady state IgG levels with subcutaneous immunoglobulin therapy (p=0.043). In a ten-month follow-up period, seven infections were observed in four patients (three upper respiratory infectons, two lower respiratory tract infections and three acute gastroenteritis). No acute severe bacterial infection was observed. Local advers reaction was reported in only 10 of 180 infusions (6%). No serious adverse events were reported. All 16 patients were willing to continue IgG replacement therapy by subcutaneous administration. CONCLUSIONS Ig replacement therapy by subcutaneous route is an efficient, safe and easy option which is eligible for individual administration. Home therapy is feasible for patients with primary immune deficiency, if informed consent is obtained and sufficient education is ensured.
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Affiliation(s)
- Elif Karakoç Aydıner
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Ayça Kıykım
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Safa Barış
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Özen
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Işıl Barlan
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
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Pulvirenti F, Granata G, Girelli G, Quinti I. Immunoglobulin-induced hemolysis, splenomegaly and inflammation in patients with antibody deficiencies. Expert Rev Clin Immunol 2016; 12:725-31. [PMID: 26854522 DOI: 10.1586/1744666x.2016.1151787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
IgG replacement for primary antibody deficiencies is a safe treatment administered to prevent recurrent infections and reduce mortality. Recently, several reports described acute hemolytic episodes following IgG administration due to a passive transfer of blood group alloantibodies, including anti-A, anti-B, as well as anti-Rh antibodies. Here, we reviewed and discussed the consequences of passively transferred RBCs antibodies. The chronic passive transfer of alloantibodies might also cause a subclinical condition due to a compensated extravascular chronic hemolysis with poorly understood consequences. This phenomenon might possibly represent an unrecognized cause of splenomegaly and might contribute to inflammation in patients with primary antibody deficiencies.
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Affiliation(s)
- Federica Pulvirenti
- a Centre for Primary Immune Deficiencies, Department of Molecular Medicine , Sapienza University of Rome , Rome , Italy
| | - Guido Granata
- a Centre for Primary Immune Deficiencies, Department of Molecular Medicine , Sapienza University of Rome , Rome , Italy
| | - Gabriella Girelli
- b Unit of Immunohematology and Transfusion Medicine , Sapienza University of Rome , Rome , Italy
| | - Isabella Quinti
- a Centre for Primary Immune Deficiencies, Department of Molecular Medicine , Sapienza University of Rome , Rome , Italy
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Berger M. Efficient Utilization of IgG for Antibody Replacement Therapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2015; 3:1001-1002. [PMID: 26553622 DOI: 10.1016/j.jaip.2015.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 06/05/2023]
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Dias C, Abosaleem B, Crispino C, Gao B, Shaywitz A. Tolerability of High-Volume Subcutaneous Injections of a Viscous Placebo Buffer: A Randomized, Crossover Study in Healthy Subjects. AAPS PharmSciTech 2015; 16:1101-7. [PMID: 25693652 DOI: 10.1208/s12249-015-0288-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/16/2014] [Indexed: 01/28/2023] Open
Abstract
Monoclonal antibody biotherapeutics are often administered by subcutaneous (SC) injection. Due to dose requirements and formulation limitations, SC injections >1 mL are often required. We used a viscous placebo buffer (5 cP), characteristic of a high-concentration antibody formulation, to investigate the effect of dose volume and injection rate on the tolerability of higher-volume SC injections. In this randomized, crossover, single-center study, 48 healthy adults received one 1.2-mL bolus injection over 5 s and three 3.5-mL injections over 1, 4, and 10 min in different abdominal quadrants, with each injection separated by approximately 2 h. The primary objective was to compare pain scores associated with the injections, immediately after administration and 1 h later, using a 100-mm visual analog scale (VAS). Secondary objectives included assessment of adverse events, including injection site reactions and swelling. Mean age was 38.4 (11.6) years and 20 subjects (42%) were female. Lowest mean VAS score was for the 10-min (6.83 mm) and highest for the 1-min injection (19.13 mm). One hour after administration, mean VAS scores were <3.5 mm for all injections. Swelling was similar among the three 3.5-mL injections. After needle removal, leakage occurred following 14 (29%) 1.2-mL injections, eight (17%) 4-min injections, five (10%) 1-min injections, and four (8%) 10-min injections. Fifteen subjects (31%) experienced an adverse event, none of which was serious, fatal, or led to study discontinuation. All injection durations were well tolerated, suggesting a single large-volume SC injection of a biotherapeutic agent could be used instead of multiple injections.
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Management of adverse events in the treatment of patients with immunoglobulin therapy: A review of evidence. Autoimmun Rev 2015; 15:71-81. [PMID: 26384525 DOI: 10.1016/j.autrev.2015.09.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 12/12/2022]
Abstract
Immunoglobulin (IG) therapy is actually used for a broad range of diseases including primary and secondary immunodeficiency disorders, and autoimmune diseases. This therapy is available for intravenous (IV) and subcutaneous (SC) administration. The efficacy of the IG therapy has been demonstrated in numerous studies and across different diseases. Generally, IG infusions are well tolerated; however some well-known adverse reactions, ranging from mild to severe, are associated with the therapy. The most common adverse reactions including headache, nausea, myalgia, fever, chills, chest discomfort, skin and anaphylactic reactions, could arise immediately during or after the infusion. Delayed events could be more severe and include migraine headaches, aseptic meningitis, haemolysis renal impairment and thrombotic events. This paper reviews all the potential adverse events related to IG therapy and establishes a comprehensive guideline for the management of these events. Moreover it resumes the opinions and clinical experience of expert endorsers on the utilization of the treatment. Published data were classified into levels of evidence and the strength of the recommendation was given for each intervention according to the GRADE system.
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