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Ramzi A, Maya S, Balousha N, Sabet H, Samir A, Roshdy MR, Aljarrah G, Saleh S, Kertam A, Serag I, Shiha MR. Subcutaneous immunoglobulins (SCIG) for chronic inflammatory demyelinating polyneuropathy (CIDP): A comprehensive systematic review of clinical studies and meta-analysis. Neurol Sci 2024:10.1007/s10072-024-07640-3. [PMID: 38937399 DOI: 10.1007/s10072-024-07640-3] [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: 04/09/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) presents significant treatment challenges due to its chronic nature, varied clinical presentations, and rarity. Subcutaneous immunoglobulin (SCIG) has emerged as a maintenance therapy, offering potential advantages in administration and patient experience over the previously recognized intravenous immunoglobulin (IVIG). METHODS We included all clinical studies involving CIDP patients treated with SCIG from eleven databases up to March 2024. RESULTS 50 clinical studies were included in the systematic review, with 22 involved in the meta-analysis. These studies offer clinical data on around 1400 CIDP patients. Almost all studies considered SCIG a maintenance therapy, with the majority of results suggesting it as a viable substitute that may offer comparable or enhanced advantages. Studies covered aspects such as efficacy, safety, quality of life, practicality, economic evaluation, and patient preference. Meta-analysis showed SCIG significantly improved muscle strength and sensory function, had fewer and milder side effects, reduced relapse rates, and received a strong preference. CONCLUSIONS Findings suggest that SCIG for CIDP maintenance not only provides a more feasible alternative, with economic evaluations showing considerable cost reductions over time, and patient preference for SCIG being pronounced, but may also deliver comparable or superior health outcomes. Ongoing research lines on formulations, techniques, and direct comparative studies are critical to further illuminate, enhance, and expand SCIG's role in treatment.
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Affiliation(s)
- Ahmed Ramzi
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Subhia Maya
- Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Haneen Sabet
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed Samir
- Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
| | | | - Ghalia Aljarrah
- Faculty of Medicine, Al-Balqa Applied University, Salt, Jordan
| | - Sireen Saleh
- Faculty of Medicine, Al-Quds University, East Jerusalem, Palestine
| | - Ahmed Kertam
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Ibrahim Serag
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Köse S, Sabetsarvestani R, Geçkil E, Kaleci E, Dönmez H. The Experiences of Children with Primary Immunodeficiency Who Receive Immunoglobulin Subcutaneously Instead of Intravenously. J Pediatr Health Care 2024; 38:13-20. [PMID: 37702646 DOI: 10.1016/j.pedhc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Children with primary immunodeficiency disorder have begun receiving subcutaneous immunoglobulin (SCIg) instead of intravenous immunoglobulin (IVIg). So, we aim to explore the experiences of primary immunodeficiency children with regard to receiving SCIg instead of IVIg. METHOD We adopted a phenomenological approach in 2022 in Turkey using semi-structured interviews. We recruited 15 participants using the purposive sampling method. RESULTS The main theme was the sweetness and bitterness of living with SCIg. The first subtheme was sweetness (sense of freedom, having a normal life, saving time, ease of use, and feeling better). The second subtheme was bitterness (worries about taking responsibility for injection, impaired body image due to abdominal edema, and minimal tolerable complications). DISCUSSION The results show these children had more sweet experiences than bitter ones. Being flexible in choosing a method, teaching patients to apply it correctly, and providing enough time to cope are as reasons for this.
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Cocito D, Peci E, Torrieri MC, Clerico M. Subcutaneous Immunoglobulin in Chronic Inflammatory Demyelinating Polyneuropathy: A Historical Perspective. J Clin Med 2023; 12:6961. [PMID: 38002576 PMCID: PMC10671960 DOI: 10.3390/jcm12226961] [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: 10/16/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
The therapeutic administration of subcutaneous immunoglobulin (SCIg) offers various advantages over intravenous immunoglobulin (IVIg). This narrative review examines and compares SCIg versus IVIg in chronic inflammatory demyelinating polyneuropathy (CIDP). SCIg is as effective as IVIg but is better tolerated and easier to administer, as intravenous access is not required. Furthermore, SCIg administration is more convenient and cost-effective than IVIg, enabling flexible treatment scheduling at home and improving patients' overall quality of life. The availability of highly concentrated immunoglobulin G (IgG) subcutaneous solutions, such as IgPro20, a 20% IgG solution stabilized with L-proline, allows for the administration of larger volumes in a single session, while the parallel development of new technological devices enables the delivery of higher doses over a shorter time. Based on the results of the PATH study, SCIg has become a well-established therapy in CIDP. In addition to discussing the advantages of SCIg, this review summarizes the evolution of SCIg by discussing all the relevant clinical studies which have considered its use in the treatment of CIDP.
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Affiliation(s)
- Dario Cocito
- Clinical and Biological Sciences Department, University of Turin, 10043 Orbassano, Italy
| | - Erdita Peci
- Clinical and Biological Sciences Department, University of Turin, 10043 Orbassano, Italy
| | | | - Marinella Clerico
- Academic Neurology Unit, San Luigi Gonzaga University Hospital, Clinical and Biological Sciences Department, University of Turin, 10043 Orbassano, Italy;
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Ahmed Meelad R, Abd Hamid IJ, Zainudeen ZT, Hashim IF, Azizuddin MNA, Mangantig E, Taib F, Mohamad N, Ismail IH, Abdul Latiff AH, Mohd Noh L. Health-Related Quality of Life of Patients and Families with Primary Immunodeficiency in Malaysia: a Cross-Sectional Study. J Clin Immunol 2023; 43:999-1006. [PMID: 36882668 PMCID: PMC9990971 DOI: 10.1007/s10875-023-01463-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Primary immunodeficiency disease (PID) affects various aspects of a patient's life. However, the health-related quality of life (HRQOL) of PID among Malaysian patients is poorly described. This study aimed to determine the quality of life of PID patients and their respective parents. METHOD This cross-sectional study was performed from August 2020 to November 2020. Patients with PID and their families were invited to answer the PedsQL Malay version (4.0) questionnaire, the tool used to assess the HRQOL. A total of 41 families and 33 patients with PID answered the questionnaire. A comparison was performed with the previously published value of healthy Malaysian children. RESULT Parents of respondents recorded a lower mean of total score than the parents of healthy children (67.26 ± 16.73 vs. 79.51 ± 11.90, p-value = 0.001, respectively). PID patients reported lower mean total score to healthy children (73.68 ± 16.38 vs. 79.51 ± 11.90, p-value = 0.04), including the psychosocial domain (71.67 ± 16.82 vs. 77.58 ± 12.63, p-value = 0.05) and school functioning (63.94 ± 20.87 vs. 80.00 ± 14.40, p-value = 0.007). No significant difference of reported HRQOL when comparing between subgroup of PID on immunoglobulin replacement therapy and those without immunoglobulin replacement (56.96 ± 23.58 vs. 65.83 ± 23.82, p-value 0.28). Socioeconomic status was found to be predictive of the lower total score of PedsQL in both parent and children reports. CONCLUSION Parents and children with PID, especially those from middle socioeconomic status, have lower HRQOL and school function impairment than healthy children.
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Affiliation(s)
- Ruwaydah Ahmed Meelad
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Institut Perubatan & Pergigian Termaju, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia
| | - Intan Juliana Abd Hamid
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Institut Perubatan & Pergigian Termaju, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia.
| | - Zarina Thasneem Zainudeen
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Institut Perubatan & Pergigian Termaju, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia
| | - Ilie Fadzilah Hashim
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Institut Perubatan & Pergigian Termaju, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia
| | - Muhd Nur Akmal Azizuddin
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Institut Perubatan & Pergigian Termaju, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia
| | - Ernest Mangantig
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Institut Perubatan & Pergigian Termaju, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia
| | - Fahisham Taib
- Paediatric Department, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Norsarwany Mohamad
- Paediatric Department, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Intan Hakimah Ismail
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | | | - Lokman Mohd Noh
- Hospital Tunku Azizah, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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Svačina MKR, Meißner A, Schweitzer F, Ladwig A, Sprenger‐Svačina A, Klein I, Wüstenberg H, Kohle F, Schneider C, Grether NB, Wunderlich G, Fink GR, Klein F, Di Cristanziano V, Lehmann HC. Antibody response after COVID-19 vaccination in intravenous immunoglobulin-treated immune neuropathies. Eur J Neurol 2022; 29:3380-3388. [PMID: 35842740 PMCID: PMC9349681 DOI: 10.1111/ene.15508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE This study assessed the prevalence of anti-SARS-CoV-2 antibodies in therapeutic immunoglobulin and their impact on serological response to COVID-19 mRNA vaccine in patients with intravenous immunoglobulin (IVIg)-treated chronic immune neuropathies. METHODS Forty-six samples of different brands or lots of IVIg or subcutaneous IgG were analyzed for anti-SARS-CoV-2 IgG using enzyme-linked immunosorbent assay and chemiluminescent microparticle immunoassay. Blood sera from 16 patients with immune neuropathies were prospectively analyzed for anti-SARS-CoV-2 IgA, IgG, and IgM before and 1 week after IVIg infusion subsequent to consecutive COVID-19 mRNA vaccine doses and after 12 weeks. These were compared to 42 healthy subjects. RESULTS Twenty-four (52%) therapeutic immunoglobulin samples contained anti-SARS-CoV-2 IgG. All patients with immune neuropathies (mean age = 65 ± 16 years, 25% female) were positive for anti-SARS-CoV-2 IgG after COVID-19 vaccination. Anti-SARS-CoV-2 IgA titers significantly decreased 12-14 weeks after vaccination (p = 0.02), whereas IgG titers remained stable (p = 0.2). IVIg did not significantly reduce intraindividual anti-SARS-CoV-2 IgA/IgG serum titers in immune neuropathies (p = 0.69). IVIg-derived anti-SARS-CoV-2 IgG did not alter serum anti-SARS-CoV-2 IgG decrease after IVIg administration (p = 0.67). CONCLUSIONS Our study indicates that IVIg does not impair the antibody response to COVID-19 mRNA vaccine in a short-term observation, when administered a minimum of 2 weeks after each vaccine dose. The infusion of current IVIg preparations that contain anti-SARS-CoV-2 IgG does not significantly alter serum anti-SARS-CoV-2 IgG titers.
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Affiliation(s)
- Martin K. R. Svačina
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Anika Meißner
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Finja Schweitzer
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Anne Ladwig
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Alina Sprenger‐Svačina
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Ines Klein
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Hauke Wüstenberg
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Felix Kohle
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Christian Schneider
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Nicolai B. Grether
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Gilbert Wunderlich
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Gereon R. Fink
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Cognitive Neuroscience, Research Center JuelichInstitute of Neuroscience and Medicine (INM‐3)JuelichGermany
| | - Florian Klein
- Institute of Virology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- German Center for Infection Research (DZIF), partner site Bonn‐CologneCologneGermany
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Helmar C. Lehmann
- Department of Neurology, Faculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
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Gonzalez NL, Juel VC, Živković SA. A Case of Probable Multifocal Motor Neuropathy With Clinical Stability for Ten Years After a Single Treatment of Rituximab. J Clin Neuromuscul Dis 2022; 23:136-142. [PMID: 35188910 DOI: 10.1097/cnd.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Multifocal motor neuropathy is a rare, immune-mediated motor neuropathy with asymmetric, often debilitating progressive weakness. The efficacy of intravenous immunoglobulin in this disease is well established; however, the response typically wanes over time. No other agent has shown similar therapeutic efficacy. We describe a case of anti-ganglioside GM1 IgM-positive multifocal motor neuropathy with typical incomplete and diminishing response to intravenous immunoglobulin over time. Sixteen years after symptom onset, rituximab was administered at 2 g/m2 over 2 weeks. No significant progression of disease has occurred over the following 10 years despite no additional treatments, including intravenous immunoglobulin, being given. Only case reports and small, mostly uncontrolled studies have reported the use of rituximab in multifocal motor neuropathy with mixed results. However, given its potential benefits and lack of an established second-line agent, treatment with rituximab may be considered in select patients with refractory multifocal motor neuropathy.
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Affiliation(s)
| | - Vern C Juel
- Department of Neurology, Duke University Hospital, Durham, NC; and
| | - Saša A Živković
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Dalakas MC. Update on Intravenous Immunoglobulin in Neurology: Modulating Neuro-autoimmunity, Evolving Factors on Efficacy and Dosing and Challenges on Stopping Chronic IVIg Therapy. Neurotherapeutics 2021; 18:2397-2418. [PMID: 34766257 PMCID: PMC8585501 DOI: 10.1007/s13311-021-01108-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 02/07/2023] Open
Abstract
In the last 25 years, intravenous immunoglobulin (IVIg) has had a major impact in the successful treatment of previously untreatable or poorly controlled autoimmune neurological disorders. Derived from thousands of healthy donors, IVIg contains IgG1 isotypes of idiotypic antibodies that have the potential to bind pathogenic autoantibodies or cross-react with various antigenic peptides, including proteins conserved among the "common cold"-pre-pandemic coronaviruses; as a result, after IVIg infusions, some of the patients' sera may transiently become positive for various neuronal antibodies, even for anti-SARS-CoV-2, necessitating caution in separating antibodies derived from the infused IVIg or acquired humoral immunity. IVIg exerts multiple effects on the immunoregulatory network by variably affecting autoantibodies, complement activation, FcRn saturation, FcγRIIb receptors, cytokines, and inflammatory mediators. Based on randomized controlled trials, IVIg is approved for the treatment of GBS, CIDP, MMN and dermatomyositis; has been effective in, myasthenia gravis exacerbations, and stiff-person syndrome; and exhibits convincing efficacy in autoimmune epilepsy, neuromyelitis, and autoimmune encephalitis. Recent evidence suggests that polymorphisms in the genes encoding FcRn and FcγRIIB may influence the catabolism of infused IgG or its anti-inflammatory effects, impacting on individualized dosing or efficacy. For chronic maintenance therapy, IVIg and subcutaneous IgG are effective in controlled studies only in CIDP and MMN preventing relapses and axonal loss up to 48 weeks; in practice, however, IVIg is continuously used for years in all the aforementioned neurological conditions, like is a "forever necessary therapy" for maintaining stability, generating challenges on when and how to stop it. Because about 35-40% of patients on chronic therapy do not exhibit objective neurological signs of worsening after stopping IVIg but express subjective symptoms of fatigue, pains, spasms, or a feeling of generalized weakness, a conditioning effect combined with fear that discontinuing chronic therapy may destabilize a multi-year stability status is likely. The dilemmas of continuing chronic therapy, the importance of adjusting dosing and scheduling or periodically stopping IVIg to objectively assess necessity, and concerns in accurately interpreting IVIg-dependency are discussed. Finally, the merit of subcutaneous IgG, the ineffectiveness of IVIg in IgG4-neurological autoimmunities, and genetic factors affecting IVIg dosing and efficacy are addressed.
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Affiliation(s)
- Marinos C Dalakas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
- Neuroimmunology Unit, Dept. of Pathophysiology, National and Kapodistrian University of Athens Medical School, Athens, Greece.
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Infusion Parameters and Demographics of Patients With Chronic Inflammatory Demyelinating Polyneuropathy During Subcutaneous Immunoglobulin Self-Administration Training. JOURNAL OF INFUSION NURSING 2021. [DOI: 10.1097/nan.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Goyal NA, Karam C, Sheikh KA, Dimachkie MM. Subcutaneous immunoglobulin treatment for chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2021; 64:243-254. [PMID: 34260074 PMCID: PMC8457117 DOI: 10.1002/mus.27356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/15/2022]
Abstract
Immunoglobulin G (IgG) therapy is an established long‐term treatment in chronic inflammatory demyelinating polyneuropathy (CIDP) that is commonly administered intravenously (IVIg). The subcutaneous immunoglobulin (SCIg) administration route is a safe and effective alternative option, approved by the United States Food and Drug Administration (FDA) in 2018, for maintenance treatment of adults with CIDP. Physicians and patients alike need to be aware of all their treatment options in order to make informed decisions and plan long‐term treatment strategies. In this review, we collate the evidence for SCIg in CIDP from all published studies and discuss their implications and translation to clinical practice. We also provide guidance on the practicalities of how and when to transition patients from IVIg to SCIg and ongoing patient support. Evidence suggests that IVIg and SCIg have comparable long‐term efficacy in CIDP. However, SCIg can provide additional benefits for some patients, including no requirement for venous access or premedication, and reduced frequency of systemic adverse events. Local‐site reactions are more common with SCIg than IVIg, but these are mostly well‐tolerated and abate with subsequent infusions. Data suggest that many patients prefer SCIg following transition from IVIg. SCIg preference may be a result of the independence and flexibility associated with self‐infusion, whereas IVIg preference may be a result of familiarity and reliance on a healthcare professional for infusions. In practice, individualizing maintenance dosing based on disease behavior and determining the minimally effective IgG dose for individuals are key considerations irrespective of the administration route chosen.
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Affiliation(s)
- Namita A Goyal
- Department of Neurology, MDA ALS and Neuromuscular Center, University of California, Irvine, California, USA
| | - Chafic Karam
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kazim A Sheikh
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Al-Zuhairy A, Sindrup SH, Jakobsen J. Long-term follow-up of facilitated subcutaneous immunoglobulin therapy in multifocal motor neuropathy. J Neurol Sci 2021; 427:117495. [PMID: 34023695 DOI: 10.1016/j.jns.2021.117495] [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: 03/01/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the feasibility, efficacy and patient satisfaction of long-term facilitated subcutaneous immunoglobulin therapy (fSCIG) in multifocal motor neuropathy (MMN). METHODS Twelve patients previously participating in a randomized trial investigating the short-term efficacy of fSCIG were offered to switch to fSCIG maintenance therapy following a variable interval on conventional subcutaneous immunoglobulin. RESULTS Eight patients were switched to fSCIG maintenance therapy, seven of whom were invited for a follow-up assessment after 18 months (range 13-23 months) of treatment. The age at follow-up was 57 years (range 45-70 years) and patients received a median weekly dose immunoglobulin G of 32.5 g (range 20.0-50.0 g), the dose being unaltered compared to baseline values following completion of the fSCIG trial. In five patients the infusion was biweekly, whereas two patients were infused weekly. The follow-up mean isometric strength normalized to pre-trial values was 107.7% (95% CI 86.4-129.0%) being non-inferior to baseline values (104.7%, 95% CI 97.6-111.8%, P = 0.015). The mean ODSS was 2.0 (95% CI 0.8-3.2) which is identical to the baseline score following completion of the fSCIG trial, the P-value for non-inferiority being <0.0001. The secondary variables of impairment, function and quality of life at follow-up all were non-inferior to baseline values (P ≤ 0.046). CONCLUSION fSCIG seems feasible and effective for long-term maintenance treatment in patients with MMN.
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Affiliation(s)
- Ali Al-Zuhairy
- Department of Neurology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Søren H Sindrup
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Johannes Jakobsen
- Department of Neurology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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11
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Long-term treatment with subcutaneous immunoglobulin in multifocal motor neuropathy. Sci Rep 2021; 11:9216. [PMID: 33911162 PMCID: PMC8080704 DOI: 10.1038/s41598-021-88711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/16/2021] [Indexed: 12/03/2022] Open
Abstract
Multifocal motor neuropathy (MMN) is a rare disease with a prevalence of less than 1 per 100,000 people. Intravenous immunoglobulin (IVIG) therapy, performed for a long-term period, has been demonstrated able to improve the clinical picture of MMN patients, ameliorating motor symptoms and/or preventing disease progression. Treatment with subcutaneous immunoglobulin (SCIg) has been shown to be as effective as IVIG. However, previously published data showed that follow-up of MMN patients in treatment with SCIg lasted no more than 56 months. We report herein the results of a long-term SCIg treatment follow up (up to 96 months) in a group of 8 MMN patients (6 M; 2F), previously stabilized with IVIG therapy. Clinical follow-up included the administration of Medical Research Council (MRC) sum-score, the Overall Neuropathy Limitation Scale (ONLS) and the Life Quality Index questionnaire (LQI) at baseline and then every 6 months. Once converted to SCIg, patients’ responsiveness was quite good. Strength and motor functions remained stable or even improved during this long-term follow-up with benefits on walking capability, resistance to physical efforts and ability in hand fine movements.
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Beydoun SR, Sharma KR, Bassam BA, Pulley MT, Shije JZ, Kafal A. Individualizing Therapy in CIDP: A Mini-Review Comparing the Pharmacokinetics of Ig With SCIg and IVIg. Front Neurol 2021; 12:638816. [PMID: 33763019 PMCID: PMC7982536 DOI: 10.3389/fneur.2021.638816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
Immunoglobulin (Ig) therapy is a first-line treatment for CIDP, which can be administered intravenously (IVIg) or subcutaneously (SCIg) and is often required long term. The differences between these modes of administration and how they can affect dosing strategies and treatment optimization need to be understood. In general, the efficacy of IVIg and SCIg appear comparable in CIDP, but SCIg may offer some safety and quality of life advantages to some patients. The differences in pharmacokinetic (PK) profile and infusion regimens account for many of the differences between IVIg and SCIg. IVIg is administered as a large bolus every 3–4 weeks resulting in cyclic fluctuations in Ig concentration that have been linked to systemic adverse events (AEs) (potentially caused by high Ig levels) and end of dose “wear-off” effects (potentially caused by low Ig concentration). SCIg is administered as a smaller weekly, or twice weekly, volume resulting in near steady-state Ig levels that have been linked to continuously maintained function and reduced systemic AEs, but an increase in local reactions at the infusion site. The reduced frequency of systemic AEs observed with SCIg is likely related to the avoidance of high Ig concentrations. Some small studies in immune-mediated neuropathies have focused on serum Ig data to evaluate its potential use as a biomarker to aid clinical decision-making. Analyzing dose data may help understand how establishing and monitoring patients' Ig concentration could aid dose optimization and the transition from IVIg to SCIg therapy.
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Affiliation(s)
- Said R Beydoun
- Neuromuscular Division, Keck School of Medicine of University of Southern California (USC), Los Angeles, CA, United States
| | - Khema R Sharma
- Neurology Department, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Bassam A Bassam
- Neurology Department, University of South Alabama College of Medicine, Mobile, AL, United States
| | - Michael T Pulley
- Department of Neurology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Jeffrey Z Shije
- Department of Neurology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Ayman Kafal
- CSL Behring, King of Prussia, PA, United States
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Kapoor M, Keh R, Compton L, Morrow S, Gosal D, Manji H, Reilly MM, Lunn MP, Lavin TM, Carr AS. Subcutaneous immunoglobulin dose titration to clinical response in inflammatory neuropathy. J Neurol 2021; 268:1485-1490. [PMID: 33608795 DOI: 10.1007/s00415-020-10318-3] [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: 07/12/2020] [Revised: 09/28/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Individualized dosing is an established approach in intravenous immunoglobulin (IVIg) treatment for inflammatory neuropathies. There is less experience in effective dosing strategies for subcutaneous (SC) immunoglobulin. METHODS We conducted a retrospective cohort study of patients with inflammatory neuropathies transferring from IVIg to SCIg in two UK peripheral nerve services. I-RODS and grip strength were used to measure outcome. Dose and clinical progress were documented at 1 year and at last review. RESULTS 44/56 patients remained on maintenance SCIg beyond 1 year (mean 3.3 years, range 1-9 years) with stable clinical outcomes. Clinical deteriorations were corrected by small increases in SCIg dose in 20 patients at 1 year, a further 9 requiring subsequent further up-titrations. Sixteen tolerated dose reduction. Mean dose change was + 2.4% from baseline. Two patients required IVIg bolus rescue (2 g/kg). Three patients successfully discontinued Ig therapy. Nine patients returned to IVIg due to clinical relapse or patient preference. Overall tolerance was good. DISCUSSION Dose titration to clinical response is an effective approach in SCIg maintenance therapy.
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Affiliation(s)
- Mahima Kapoor
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Ryan Keh
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital Trust, Stott Lane, Salford, UK
| | - Laura Compton
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Sarah Morrow
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital Trust, Stott Lane, Salford, UK
| | - David Gosal
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital Trust, Stott Lane, Salford, UK
| | - Hadi Manji
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Michael P Lunn
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Tim M Lavin
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital Trust, Stott Lane, Salford, UK
| | - Aisling S Carr
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
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14
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Alzuabi MA, Manolopoulos A, Elmashala A, Odabashian R, Naddaf E, Murad MH. Immunoglobulin for myasthenia gravis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Muayad A Alzuabi
- Department of Neuroscience, Division of Clinical Neurology; Medical University of South Carolina; Charleston SC USA
| | - Apostolos Manolopoulos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Amjad Elmashala
- Department of Neurology; Iowa University Hospitals; Iowa City IA USA
| | - Roupen Odabashian
- Department of Internal Medicine; University of Toronto; Toronto Canada
| | - Elie Naddaf
- Department of Neurology; Mayo Clinic; Rochester MN USA
| | - M Hassan Murad
- Mayo Evidence-based Practice Center (EPC); Mayo Clinic; Rochester MN USA
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15
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Perraudin C, Bourdin A, Vicino A, Kuntzer T, Bugnon O, Berger J. Home-based subcutaneous immunoglobulin for chronic inflammatory demyelinating polyneuropathy patients: A Swiss cost-minimization analysis. PLoS One 2020; 15:e0242630. [PMID: 33237959 PMCID: PMC7688145 DOI: 10.1371/journal.pone.0242630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare the cost of two patient management strategies with similar efficacies for chronic inflammatory demyelinating polyneuropathy (CIDP) patients in the chronic phase: hospital-based IV immunoglobulin G (IVIg) and home-based subcutaneous immunoglobulin G (SCIg) associated with an interprofessional drug therapy management programme (initial training and follow-up). METHODS A 48-week model-based cost-minimization analysis from a societal perspective was performed. Resources included immunoglobulin (IVIg: 1 g/kg/3 weeks; SCIg: 0.4 g/kg/week initially and 0.2 g/kg/week in the maintenance phase), hospital charges, time of professionals, infusion material, transport and losses of productivity for patients. Costs were expressed in Swiss francs (CHF) (1 CHF = 0.93€ = US$1.10, www.xe.com, 2020/10/28). RESULTS The total costs of IVIg were higher than those of SCIg for health insurance and other payers: 114,747 CHF versus 86,558 CHF and 8,762 CHF versus 2,401 CHF, respectively. The results were sensitive to the immunoglobulin doses, as this was the main cost driver. The SCIg daily cost in the initial phase was higher for health insurance than hospital-based IVIg was, but the additional costs were compensated during the maintenance phase (from week 28). The professional costs associated with the switch were not fully covered by the insurance and were borne by the pharmacist and the nurse. CONCLUSIONS SCIg for CIDP patients reinforced by an interprofessional drug therapy management programme may be a cost-effective and sustainable alternative to IVIg in the Swiss system context. From an economic perspective, this therapy alternative should be more widely supported by healthcare systems and proposed to eligible patients by professionals.
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Affiliation(s)
- Clémence Perraudin
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- * E-mail:
| | - Aline Bourdin
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Alex Vicino
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
| | - Jérôme Berger
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
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16
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Piscitelli E, Massa M, De Martino BM, Serio CS, Guglielmi G, Colacicco G, Tuccillo F, Habetswallner F. Economic evaluation of subcutaneous versus intravenous immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy: a real-life study. Eur J Hosp Pharm 2020; 28:e115-e119. [PMID: 33122403 DOI: 10.1136/ejhpharm-2020-002430] [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: 06/27/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired peripheral neuropathy of immunological origin with a clinical presentation and course that are extremely variable. The therapeutic approach generally includes corticosteroid drugs, intravenous immunoglobulins (IVIGs) or plasmapheresis alone or in combination as first line therapy, and immunosuppressants. In 2014 the Italian regulatory agency included subcutaneous immunoglobulins (SCIGs) in the list of off-label drugs reimbursed by the national health service. Our aim is to compare costs and outcomes of IVIG versus SCIG therapy. METHODS Patients medical records and therapeutic plans were retrospectively analysed to collect data on IVIG treatments 1 year before the switch to SCIG, and after 1 year of treatment with SCIG. A budget impact analysis was conducted through resource identification and quantification, and healthcare and non-health care costs evaluation. RESULTS 13 of 34 patients affected by CIDP who were referred to our neurophysiopathological unit and treated with IVIG were switched to home-based SCIG. After 1 year of receiving SCIG, 12 patients remained neurologically stable and reported good outcomes. Considering the cost of IVIG (€30.97/g) and adding to this the direct and indirect healthcare costs, the total cost of IVIG treatment for the 12 patients in a year was €371 417.06, compared with the cost of SCIG (€51.57/g) for a total annual cost of €631 745.16, not including indirect costs. CONCLUSIONS We observe a higher cost for SCIG treatment versus IVIG, which is not in line with data in the literature. However, SCIGs offer some important safety benefits and improvements in patient quality of life.
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Affiliation(s)
| | - Marida Massa
- U.O.C. Farmacia, Ospedale Cardarelli, Napoli, Italy
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17
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Rajabally YA, Fatehi F. Outcome measures for chronic inflammatory demyelinating polyneuropathy in research: relevance and applicability to clinical practice. Neurodegener Dis Manag 2020; 9:259-266. [PMID: 31580223 DOI: 10.2217/nmt-2019-0009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Outcome measures are recommended in the management of chronic inflammatory demyelinating polyneuropathy (CIDP). Various scales have been proposed in recent years, some now commonly utilized in daily clinical practice. The available evidence base relies itself on randomized controlled trial data obtained over the past 30 years, with several studies using different primary and secondary outcomes. We here review the different outcome measures used in CIDP research in relation to those currently recommended for clinical management. We consider the evidence base for CIDP treatment from the primary and secondary outcomes used in these studies and attempt to assess how this may relate to current clinical practice of routine evaluation of treatment effects and long-term monitoring.
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Affiliation(s)
- Yusuf A Rajabally
- School of Life & Health Sciences & Aston Medical School, Aston University, Birmingham, UK.,Regional Neuromuscular Service, University Hospitals Birmingham, Birmingham, UK
| | - Farzad Fatehi
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Aix Marseille University, CNRS (UMR 7339), Centre de Résonance Magnétique Biologique et Médicale, Faculté de Médecine, 27 bd. J. Moulin, 13005 Marseille, France
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18
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Herraets I, van Rosmalen M, Bos J, van Eijk R, Cats E, Jongbloed B, Vlam L, Piepers S, van Asseldonk JT, Goedee HS, van den Berg L, van der Pol WL. Clinical outcomes in multifocal motor neuropathy: A combined cross-sectional and follow-up study. Neurology 2020; 95:e1979-e1987. [PMID: 32732293 DOI: 10.1212/wnl.0000000000010538] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/17/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the clinical course of multifocal motor neuropathy (MMN) in a large cohort of patients and to identify predictive factors of a progressive disease course. METHODS Between May 2015 and February 2016, we collected clinical data from 100 patients with MMN, of whom 60 had participated in a nationwide cross-sectional cohort study in 2007. We documented clinical characteristics using standardized questionnaires and performed a standardized neurologic examination. We used multiple linear regression analysis to identify factors that correlated with worse outcome. RESULTS We found that age at diagnosis (45.2 vs 48.6 years, p < 0.02) was significantly increased between 2007 and 2015-2016, whereas diagnostic delay decreased by 15 months. Seven out of 10 outcome measures deteriorated over time (all p < 0.01). Patients who had a lower Medical Research Council (MRC) sumscore and absence of 1 or more reflexes at the baseline visit showed a greater functional loss at follow-up (p = 0.007 and p = 0.016). CONCLUSIONS Our study shows that MMN is a progressive disease. Although 87% of patients received maintenance treatment, muscle strength, reflexes, vibration sense, and the Self-Evaluation Scale score significantly deteriorated over time. Lower MRC sumscore and absence of reflexes predicted a more progressive disease course. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that lower MRC sumscore and the absence of reflexes predict a more progressive disease course in patients with MMN.
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Affiliation(s)
- Ingrid Herraets
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Marieke van Rosmalen
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Jeroen Bos
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Ruben van Eijk
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Elies Cats
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Bas Jongbloed
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Lotte Vlam
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Sanne Piepers
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Jan-Thies van Asseldonk
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - H Stephan Goedee
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - Leonard van den Berg
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands
| | - W Ludo van der Pol
- From the Department of Neurology and Neurosurgery (I.H., M.v.R., J.B., R.v.E., H.S.G., L.v.d.B., W.L.v.d.P.), UMC Utrecht Brain Center Rudolf Magnus; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care (R.v.E.), University Medical Center Utrecht; Department of Neurology (E.C.), Gelre Hospital, Apeldoorn; Department of Neurology (B.J.), Admiraal de Ruyter Hospital, Goes; Department of Neurology (L.V.), Erasmus Medical Center, Rotterdam; Department of Neurology (S.P.), Meander Medical Center, Amersfoort; and Department of Neurology and Clinical Neurophysiology (J.-T.v.A.), Elisabeth-Tweesteden Hospital Tilburg, the Netherlands.
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Tichy EM, Prosser B, Doyle D. Expanding the Role of the Pharmacist: Immunoglobulin Therapy and Disease Management in Neuromuscular Disorders. J Pharm Pract 2020; 35:106-119. [PMID: 32677504 PMCID: PMC8822190 DOI: 10.1177/0897190020938212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Immunoglobulin G (IgG) is a commonly used treatment for chronic neuromuscular
disorders (NMDs), such as chronic inflammatory demyelinating polyneuropathy and
multifocal motor neuropathy. IgG therapy has also shown promise in treating
other NMDs including myasthenia gravis, polymyositis, and dermatomyositis. IgG
is administered as either intravenous immunoglobulin (IVIg) or subcutaneous
immunoglobulin (SCIg), with SCIg use becoming more popular due to the treatment
burden associated with IVIg. IVIg requires regular venous access; long infusions
(typically 4-6 hours); and can result in systemic adverse events (AEs) for some
patients. In contrast, SCIg can be self-administered at home with shorter
infusions (approximately 1 hour) and fewer systemic AEs. As patient care shifts
toward home-based settings, the role of the pharmacist is paramount in providing
a continuation of care and acting as the bridge between patient and clinic.
Pharmacists with a good understanding of current recommendations, dosing
strategies, and administration routes for IgG therapy are best placed to support
patients. The aims of this review are to highlight the evidence supporting IgG
therapy in the treatment of NMDs and provide practical information on patient
management and IVIg/SCIg dosing in order to guide pharmacists on optimizing
clinical outcomes and patient care.
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Affiliation(s)
- Eric M Tichy
- Pharmacy Supply Solutions, Supply Chain Management, Mayo Clinic, Rochester, MN, USA
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20
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Gentile L, Mazzeo A, Russo M, Arimatea I, Vita G, Toscano A. Long-term treatment with subcutaneous immunoglobulin in patients with chronic inflammatory demyelinating polyradiculoneuropathy: a follow-up period up to 7 years. Sci Rep 2020; 10:7910. [PMID: 32404895 PMCID: PMC7220943 DOI: 10.1038/s41598-020-64699-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022] Open
Abstract
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare and heterogeneous acquired sensory-motor polyneuropathy with autoimmune pathogenesis. Intravenous immunoglobulins (IVIG) are a well-established therapy for CIDP: it is well known that at least two-thirds of these patients need these infusions for several years. More recently, Subcutaneous Immunoglobulins (SCIg) have been proved to be effective: this finding has been confirmed either in isolated cases or in few randomized trials. However, it appeared that the longest SCIg treatment follow up lasted no longer than 48 months. We report herein the results of a long-term SCIg treatment with a follow up period up to 7 years (84 months), considering safety, tolerability and patients’ perception of SCIg treatment in a CIDP population. We studied 17 patients (10 M; 7 F) with a diagnosis of CIDP, defined according to the EFNS/PNS criteria, successfully treated with IVIG every 4/6 weeks before being switched to SCIg treatment. Clinical follow-up included, apart from a routinely clinical assessment, the administration of Medical Research Council (MRC) sum-score, the Overall Neuropathy Limitation Scale (ONLS) and the Life Quality Index questionnaire (LQI). The results showed that, in the majority of this pre-selected group of CIDP patients (16/17), SCIg were well tolerated and were preferred over IVIG. Strength and motor functions remained stable or even improved during the long term follow-up (up to 84 months) with benefits on walking capability and resistance, manual activity performances and fatigue reduction.
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Affiliation(s)
- L Gentile
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - A Mazzeo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M Russo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - I Arimatea
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G Vita
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Toscano
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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21
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Al‐Zuhairy A, Sindrup SH, Andersen H, Jakobsen J. A population‐based study of long‐term outcome in treated chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2020; 61:316-324. [DOI: 10.1002/mus.26772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ali Al‐Zuhairy
- Department of NeurologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Søren H. Sindrup
- Department of NeurologyOdense University Hospital Odense Denmark
| | - Henning Andersen
- Department of NeurologyAarhus University Hospital Aarhus Denmark
| | - Johannes Jakobsen
- Department of NeurologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
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22
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Cirillo G, Todisco V, Ricciardi D, Tedeschi G. Clinical‐neurophysiological correlations in chronic inflammatory demyelinating polyradiculoneuropathy patients treated with subcutaneous immunoglobulin. Muscle Nerve 2019; 60:662-667. [DOI: 10.1002/mus.26669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Giovanni Cirillo
- Division of Neurology and NeurophysiopathologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
- Division of Human Anatomy–Laboratory of Neuronal Networks MorphologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
| | - Vincenzo Todisco
- Division of Neurology and NeurophysiopathologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
| | - Dario Ricciardi
- Division of Neurology and NeurophysiopathologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
| | - Gioacchino Tedeschi
- Division of Neurology and NeurophysiopathologyUniversity of Campania “Luigi Vanvitelli” Naples Italy
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23
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Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for Neurological Patients. Can J Neurol Sci 2019; 46:38-43. [PMID: 30688201 DOI: 10.1017/cjn.2018.363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Subcutaneous immunoglobulin (SCIg) treatment has been shown to control symptoms and improve overall satisfaction in patients with neurological disorders. However, a large injection volume can be overwhelming and a barrier to successful SCIg treatment. We established a nurse-led individualized approach program to facilitate a smooth and successful treatment transition from intravenous immunoglobulin (IVIg) to SCIg. The program involved a lead nurse to provide two or more individual educational sessions on SCIg administration, establish a written transition plan, and liaise care with physicians. OBJECTIVES We aimed to evaluate the impact of our program to a successful transition defined as SCIg retention or adherence without a need to restart IVIg by six or twelve months. METHODS We reviewed medical charts of all patients with immune-mediated neuromuscular disorders who were in our program during January 2010 to Dec 2016. RESULTS Nineteen patients were identified. Mean IVIg treatment duration was 31.5 months (range 4-98) before the transition. Mean steady state SCIg dosage was 26.2 g/week (SD 10.3). All patients were initially able to switch to SCIg, with a retention rate of 17/19 (89.5%) at six months and 15/19 (78.9%) at twelve months. Two patients reverted back to IVIg treatment due to worsening of their symptoms at two and three months, while two required supplemental IVIg infusions. There were no major adverse events reported during the twelve-month period, but one minor cutaneous adverse event (redness around the injection site). CONCLUSIONS Successful treatment transition may be achieved with the nurse led individualized approach program.
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24
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Herraets IJT, Bakers JNE, van Eijk RPA, Goedee HS, van der Pol WL, van den Berg LH. Human immune globulin 10% with recombinant human hyaluronidase in multifocal motor neuropathy. J Neurol 2019; 266:2734-2742. [PMID: 31325017 PMCID: PMC6803588 DOI: 10.1007/s00415-019-09475-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 11/26/2022]
Abstract
Objective The primary aim was to determine the safety of treatment with human immune globulin 10% with recombinant human hyaluronidase (fSCIg) compared to intravenous immunoglobulin (IVIg) in a prospective open-label study in patients with multifocal motor neuropathy (MMN). Methods Our study consisted of two phases: the IVIg phase (visits 1–3; 12 weeks), in which patients remained on IVIg treatment, and the fSCIg phase (visits 4–7; 36 weeks), in which patients received fSCIg treatment. After visit 3, IVIg was switched to an equivalent dose and frequency of fSCIg. Outcome measures were safety, muscle strength, disability and treatment satisfaction. Results Eighteen patients were enrolled in this study. Switching to fSCIg reduced the number of systemic adverse events (IVIg 11.6 vs. fSCIg 5.0 adverse events/per person-year, p < 0.02), and increased the number of local reactions at the injection site (IVIg 0 vs. fSCIg 3.3 local reactions/per person-year, p < 0.01). Overall, no significant differences in muscle strength and disability between fSCIg and IVIg were found. Treatment with fSCIg was perceived as optimal treatment option by 8 of the 17 patients (47.1%) and they continued with fSCIg after study closure because of improved independence and flexibility to administer treatment. Conclusion Treatment with fSCIg can be considered a safe alternative for patients with MMN on IVIg treatment. fSCIg could be a favorable option in patients who prefer self-treatment and more independency, and in patients who experience systemic adverse events on IVIg or have difficult intravenous access. Electronic supplementary material The online version of this article (10.1007/s00415-019-09475-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid J T Herraets
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center Rudolf Magnus, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jaap N E Bakers
- Department of Rehabilitation, Brain Center Rudolf Magnus, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center Rudolf Magnus, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center Rudolf Magnus, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center Rudolf Magnus, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center Rudolf Magnus, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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25
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Al‐Zuhairy A, Jakobsen J, Andersen H, Sindrup SH, Markvardsen LK. Randomized trial of facilitated subcutaneous immunoglobulin in multifocal motor neuropathy. Eur J Neurol 2019; 26:1289-e82. [DOI: 10.1111/ene.13978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
Affiliation(s)
- A. Al‐Zuhairy
- Department of Neurology Copenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| | - J. Jakobsen
- Department of Neurology Copenhagen University Hospital (Rigshospitalet) Copenhagen Denmark
| | - H. Andersen
- Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - S. H. Sindrup
- Department of Neurology Odense University Hospital Odense Denmark
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26
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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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27
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Through the Skin, To the Nerves: Subcutaneous Immunoglobulin for Neuromuscular Diseases. Can J Neurol Sci 2019; 46:1-2. [DOI: 10.1017/cjn.2018.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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28
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Markvardsen LK, Carstens AKR, Knak KL, Overgaard K, Vissing J, Andersen H. Muscle Strength and Aerobic Capacity in Patients with CIDP One Year after Participation in an Exercise Trial. J Neuromuscul Dis 2018; 6:93-97. [PMID: 30507584 DOI: 10.3233/jnd-180344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We have previously shown that patients with chronic inflammatory demyelinating polyneuropathy (CIDP) improve muscle strength and aerobic capacity after resistance and aerobic exercise. OBJECTIVE The purpose of this study was to determine if muscle strength and aerobic capacity are preserved one year after discontinuation of regular exercise. METHODS All patients in the previous exercise study were eligible for a one-year follow-up with measurement of combined isokinetic muscle strength (cIKS) by dynamometry and maximal oxygen consumption velocity (VO2-max). Data are presented as median (ranges). RESULTS Ten of 17 patients accepted to participate in the follow-up study. Following the exercise study six patients discontinued exercise and at one-year follow-up cIKS had decreased by -13.0 % (-25.8 to -2.9) (p = 0.03) and VO2-max by -16.6 % (-18.8 to -12.6) (p = 0.06). Four patients continued exercise (three with aerobic training and one with resistance training) and at one-year follow-up cIKS and VO2-max were preserved compared to the end of the exercise study (11.6 % (-8.9 to 32.1) (p = 0.88) and -8.4 % (-34.5 to -2.2) (p = 0.13), respectively). CONCLUSIONS Continuation of aerobic and resistance exercise may preserve gains in muscle strength and aerobic capacity in patients with CIDP.
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Affiliation(s)
| | | | - Kirsten L Knak
- Department of Neurology, Copenhagen Neuromuscular Center, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Overgaard
- Department of Public Health, Section for Sport Science, Aarhus University, Aarhus, Denmark
| | - John Vissing
- Department of Neurology, Copenhagen Neuromuscular Center, Rigshospitalet, Copenhagen, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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29
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Rosier C, Graveline N, Lacour A, Antoine JC, Camdessanché JP. Intravenous immunoglobulin for treatment of chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy in France: are daily practices in accordance with guidelines? Eur J Neurol 2018; 26:575-580. [PMID: 30326184 DOI: 10.1111/ene.13841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) are rare autoimmune diseases. Guidelines were published in 2010 for their diagnosis and treatment. In France, intravenous immunoglobulins (IVIGs) are mainly used for the first-line treatment. The burden of healthcare costs is often underlined but rarely studied. The aim of this survey was to compare to guidelines, the daily practice of French neurologists with IVIGs for CIDP and MMN treatment. METHODS This was a retrospective observational study consisting of an online questionnaire performed between March and May 2014. A total of 49 questionnaires were included, a quarter of which were from neurologists working in neuromuscular reference centers (NRCs). RESULTS A total of 182 patient case reports were studied. Patients were referred to an NRC for initial diagnosis in approximately 30% of cases in CIDP and 50% of cases in MMN. The initial management of IVIG (frequency, dose and duration) was not different between NRCs and non-NRCs. Guidelines were followed and neurologists were relatively at ease in diagnosing and treating patients. CONCLUSIONS This was the first national study to describe the implementation of the European Federation of Neurological Sciences/Peripheral Nerve Society guidelines in the daily management of IVIGs in patients with MMN and CIDP in France. Efforts are needed to improve long-term tailored treatment and home treatment to reduce economic costs.
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Affiliation(s)
- C Rosier
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne
| | - N Graveline
- Laboratoire Français du Fractionnement et des Biotechnologies Biomédicaments, Courtaboeuf
| | - A Lacour
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne.,Centre Référent Maladies Neuromusculaires Rares Provence Alpes Côte d'Azur Rhône-Alpes Réunion, Saint-Etienne, France
| | - J-C Antoine
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne.,Centre Référent Maladies Neuromusculaires Rares Provence Alpes Côte d'Azur Rhône-Alpes Réunion, Saint-Etienne, France
| | - J-P Camdessanché
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne.,Centre Référent Maladies Neuromusculaires Rares Provence Alpes Côte d'Azur Rhône-Alpes Réunion, Saint-Etienne, France
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30
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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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31
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Ortega-López MC, Garay J, Pinilla ML. Efficacy, safety and quality of life in patients receiving subcutaneous IgG treatment: experience in Bogotá, Colombia. Immunotherapy 2018; 10:861-869. [PMID: 29761739 DOI: 10.2217/imt-2018-0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIM Investigate efficacy, safety and quality of life of Gammanorm® 16.5% (subcutaneous immunoglobulin [SCIG]) in patients with primary immunodeficiencies (PIDs) and safety and to lesser extent efficacy in autoimmune diseases. PATIENTS & METHODS Medical records were extracted from 31 pediatric and 12 adult patients who received SCIG as part of the Personalized Program at University Children's Hospital, Bogotá, Colombia. RESULTS Mean SCIG dose was 28.7 g/month. Serious bacterial infections were observed in 7/33 patients in the PID group, most often bacterial pneumonia (3/33). There were no serious adverse events related to SCIG treatment. Drug-related adverse reactions were reported in 2/43 patients. CONCLUSION Self-administration of SCIG provided effective protection, favorable tolerability and improved quality of life in patients with PIDs and autoimmune diseases from Colombia.
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Affiliation(s)
- María Claudia Ortega-López
- Hospital Infantil Universitario de San José, Departamento de Pediatría, Carrera 52 # 67A-71, Bogotá, Colombia
| | - Javier Garay
- Pontificia Universidad Javeriana, Departamento de Epidemiología Clínica, Bogotá, Colombia
| | - Mónica León Pinilla
- Hospital Infantil Universitario de San José, Departamento de Pediatría, Carrera 52 # 67A-71, Bogotá, Colombia
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32
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Cirillo G, Todisco V, Tedeschi G. Long-term neurophysiological and clinical response in patients with chronic inflammatory demyelinating polyradiculoneuropathy treated with subcutaneous immunoglobulin. Clin Neurophysiol 2018; 129:967-973. [DOI: 10.1016/j.clinph.2018.01.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/22/2017] [Accepted: 01/21/2018] [Indexed: 11/30/2022]
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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. 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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