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Geng B, Clark K, Evangelista M, Wolford E. Low rates of headache and migraine associated with intravenous immunoglobulin infusion using a 15-minute rate escalation protocol in 123 patients with primary immunodeficiency. Front Immunol 2023; 13:1075527. [PMID: 36818468 PMCID: PMC9932595 DOI: 10.3389/fimmu.2022.1075527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/16/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Headache and migraine adverse events are common concerns in the administration of intravenous immune globulins (IVIG). Trials of IVIG for primary immunodeficiency (PI) are typically small and have reported headache and migraine data inconsistently. Methods We analyzed headache and migraine in pooled data from three pivotal trials of Gammaplex® 5% and 10% in PI (NCT00278954 from January 18, 2006; NCT01289847 from January 27, 2011; NCT01963143 from September 13, 2013). The trials were pooled in a retrospective analysis that included two 12-month open-label non-comparative trials of the 5% IVIG product and one 6-month open-label crossover bioequivalence trial comparing the 5% IVIG and 10% IVIG products. The population included adult and pediatric patients, who received IVIG infusions of 300-800 mg/kg/infusion every 21 or 28 days using a 15-minute rate escalation protocol. Results In total, 1482 infusions were administered to 123 patients, with 94.6% of infusions achieving the maximum infusion rate. At least one product-related headache was reported in 6.1% (90/1482) of infusions. At least one product-related migraine was reported in 0.5% (7/1482) of infusions. Headache rates were higher for adults vs pediatric patients, females vs males, and 21-day vs 28-day dosing schedules, but were similar for the 5% and 10% IVIG products. Most headaches and migraines occurred during or within 72 hours of the infusion. Rates decreased after the first few infusions. Discussion Patients receiving this IVIG product on a 15-minute rate escalation protocol had low rates of headache and migraine for both the 5% and 10% formulations.
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Affiliation(s)
- Bob Geng
- Division of Allergy & Immunology, University of California, San Diego, CA, United States
| | - Kim Clark
- Global Medical Department, Bio Products Laboratory, Ltd., Elstree, United Kingdom
| | - Mark Evangelista
- Biostatistics Department, Atlantic Research Group, Charlottesville, VA, United States
| | - Eric Wolford
- Global Medical Department, Bio Products Laboratory, Ltd., Elstree, United Kingdom
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Kriván G, Borte M, Harris JB, Lumry WR, Aigner S, Lentze S, Staiger C. Efficacy, safety and pharmacokinetics of a new 10% normal human immunoglobulin for intravenous infusion, BT595, in children and adults with primary immunodeficiency disease. Vox Sang 2022; 117:1153-1162. [PMID: 35944615 DOI: 10.1111/vox.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the efficacy, safety and pharmacokinetics of a new, highly purified 10% IVIg (BT595, Yimmugo®) administered in children and adults with Primary immunodeficiency diseases (PID). MATERIALS AND METHODS Prospective, uncontrolled, multicentre Phase III trial. Patients aged 2 to <76 years with PID were switched from their pre-trial IVIg replacement therapy to BT595. In all, 67 patients (49 adults, 18 children) received doses between 0.2 and 0.8 g/kg body weight for approximately 12 months at intervals of 3 or 4 weeks. Dosing and dosing intervals were based on each patient's pre-trial infusion schedule. The primary end point was the rate of acute serious bacterial infections (SBIs); secondary efficacy, safety and pharmacokinetic outcomes were also evaluated. RESULTS The primary efficacy end point was met, and the unadjusted SBI rate was 0.01 per subject-year (adjusted SBI rate 0.015 per subject-year, with an upper limit of the one-sided 99% confidence interval of 0.151). A single adult patient experienced one event classified as an SBI. All secondary end points, including those related to infections, supported the efficacy. Infusion rates were increased up to 8 ml/kg/h. Overall, 8% of infusions were associated with ≥1 infusional adverse event (AE) (start during or within 72 h post-infusion), comprising mainly headache (2.4%), fatigue (0.9%) and nausea (0.5%). There were no infusional AEs at infusion rates of >4.0 ml/kg/h, and only one patient required a single premedication. The observed patterns, severity and frequency of treatment-emergent adverse events are consistent with the established safety profile for IVIgs and did not show clinically relevant differences between all age groups. CONCLUSION BT595 is effective, safe and well tolerated for treating patients with PID.
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Affiliation(s)
- Gergely Kriván
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Michael Borte
- ImmunDeficiencyCenter Leipzig (IDCL) at Klinikum St. Georg gGmbH, Leipzig, Germany
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Jiang Y, Mendoza M, Sarpong E, Mannan S, Ng E, Katzberg H, Bril V, Barnett C. Efficacy and safety of high infusion rate IVIG in CIDP. Muscle Nerve 2020; 62:637-641. [PMID: 32785949 DOI: 10.1002/mus.27044] [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: 01/10/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND We aimed to determine the safety and tolerance of higher rates of infusion of intravenous immunoglobulin (IVIG) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS Patients began infusions with 10% IVIG at the standard rate of 0.08 mL/kg/min. If tolerated, infusion rates were incrementally increased to 0.14 mL/kg/min. We considered the frequency of infusions with adverse events (AEs) as the primary outcome. RESULTS Nineteen of 25 patients safely tolerated the maximum rate of 0.14 mL/kg/min. We observed 25 treatment-related AEs (TAEs) over 13 infusions at standard or transitional rates, across seven patients. We observed no TAEs associated with the maximum infusion rate. CONCLUSIONS We found that 10% IVIG can be safely administered at a high infusion rate (0.14 ml/kg/min) in most CIDP patients, reducing the treatment time and burden on healthcare resources.
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Affiliation(s)
- Yue Jiang
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto, Ontario, Canada
| | - Meg Mendoza
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto, Ontario, Canada
| | - Evelyn Sarpong
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto, Ontario, Canada
| | | | - Eduardo Ng
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto, Ontario, Canada
| | - Hans Katzberg
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto, Ontario, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto, Ontario, Canada
| | - Carolina Barnett
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto, Ontario, Canada
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Alsina L, Mohr A, Montañés M, Oliver X, Martín E, Pons J, Drewe E, Papke J, Günther G, Chee R, Gompels M. Surveillance study on the tolerability and safety of Flebogamma ® DIF (10% and 5% intravenous immunoglobulin) in adult and pediatric patients. Pharmacol Res Perspect 2018; 5. [PMID: 28971614 PMCID: PMC5625155 DOI: 10.1002/prp2.345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022] Open
Abstract
Direct comparisons of tolerability and safety of concentrated intravenous immunoglobulin (IVIG) versus less concentrated products are scarce. In this postauthorization, prospective, observational, multicenter study, a systematic comparison of 10% and 5% concentrations of Flebogamma® DIF IVIG was performed in both adult and pediatric patients treated with the studied IVIG products according to the approved indications under routine conditions. Dose of product administered, adverse events (AEs), physical assessments, laboratory tests, and concomitant therapy were analyzed. Patient recruitment in the 10% and 5% product groups was, respectively, 34 (32 analyzed, 13 of them children, receiving 130 IVIG infusions) and 35 (34 analyzed, receiving 135 IVIG infusions). Twenty‐four infusions (18.5%; 95% CI: 11.8, 25.1) with the 10% product and 3 (2.2%; 95% CI: −0.3, 4.7) with the 5% product were associated with potentially treatment‐related AEs (P < 0.0001). Nine patients (28.1%) infused with the 10% product and 3 (8.8%) infused with the 5% product presented, respectively, 33 and 8 treatment‐related AEs (of which 7 and 6, respectively, were serious AEs, experienced by only three hypersensitive patients). The profile of AEs occurring with the infusion of 10% and 5% products were comparable. The most frequent treatment‐related AEs were headache (n = 17, 3 patients; 15 episodes, 1 patient) and pyrexia (n = 6, 4 patients). In conclusion, no unpredictable risk was detected for both Flebogamma DIF 10% and 5% concentrations, which were therefore deemed as safe and well‐tolerated IVIG in the studied population. The frequency of infusions associated with treatment‐related AEs was lower with the 5% concentration.
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Affiliation(s)
- Laia Alsina
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Passeig de Sant, Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Andreas Mohr
- Hematology and Oncology, OncoResearch Lerchenfeld, Lerchenfeld 14, 22081, Hamburg, Germany
| | - Maria Montañés
- Pharmacovigilance Department, Instituto Grifols S.A., Avinguda de la Generalitat 152-158, 08174, Sant Cugat del Vallès, Barcelona, Spain
| | - Xènia Oliver
- Pharmacovigilance Department, Instituto Grifols S.A., Avinguda de la Generalitat 152-158, 08174, Sant Cugat del Vallès, Barcelona, Spain
| | - Esperanza Martín
- Pneumology Service, Hospital Sant Joan de Déu, Fundació Althaia. Carrer Dr. Joan Soler, s/n, 08243, Manresa, Spain
| | - Jaime Pons
- Immunology Service, Hospital Son Espases, Carrer de Valldemossa 79, 07120, Palma de Mallorca, Spain
| | - Elizabeth Drewe
- Clinical Immunology and Allergy Department, Nottingham University Hospitals - QMC Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Jens Papke
- Practice and Day Clinic for Internal Medicine and Oncology, Rosa-Luxemburg-Straße 6, 01844, Neustadt in Sachsen, Germany
| | - Georg Günther
- Medical Healthcare Centre for Blood and Cancer Diseases, Kurfürstenstraße 20, D-14467, Potsdam, Germany
| | - Ronnie Chee
- Clinical Immunology Department, Royal Free London NHS Foundation Trust, 17 Lyndhurst Gardens, London, NW3 5NU, UK
| | - Mark Gompels
- Immunology and Allergy Department, Southmead Hospital, Dorian Way, Westbury-on-Trym, Bristol, BS10 5NB, UK
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A nursing protocol for safe IVIG administration. Nursing 2017; 47:15-19. [PMID: 28746095 DOI: 10.1097/01.nurse.0000521046.11691.0f] [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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Hodkinson JP. Considerations for dosing immunoglobulin in obese patients. Clin Exp Immunol 2017; 188:353-362. [PMID: 28263379 PMCID: PMC5422718 DOI: 10.1111/cei.12955] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/17/2022] Open
Abstract
Obesity is a very common condition; however, the effect of excess body weight on the appropriate dose of immunoglobulin has not been defined empirically. The proposed pharmacokinetic differences between lean and obese patients and the opportunity to reduce costs has led to the proposition that obese patients should receive proportionally lower doses of immunoglobulin once a certain threshold is reached. Here the theoretical factors which could affect dosing in obese patients are considered alongside the available empirical evidence. The available evidence indicates that obesity may affect the pharmacokinetics of immunoglobulin; however, the effect is likely to be too small to have a clinically important effect on dosing. Wide interpatient individuality and highly variable clinical need mean that obesity should not play a major factor in dosing considerations. However, patients who are obese are more likely to have multiple cardiovascular risk factors and their weight indicates a large dose. This puts these patients at a higher risk of adverse reactions, and therefore caution is advised.
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Affiliation(s)
- J P Hodkinson
- Corporate Medical Affairs, Biotest AG, Dreieich, Germany
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Spadaro G, Vultaggio A, Alberto Bosi A, Reichert D, Janssen J, Lamacchia D, Nappi L, Pecoraro A, Milito C, Ferraro A, Matucci A, Bacchiarri F, Carrai V, Hibbeler A, Speckman E, Guarnieri C, Bongiovanni S, Quinti I. Rapid infusions of human normal immunoglobulin 50g/l are safe and well tolerated in immunodeficiencies and immune thrombocytopenia. Int Immunopharmacol 2017; 44:38-42. [PMID: 28073042 DOI: 10.1016/j.intimp.2016.12.030] [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: 10/03/2016] [Revised: 12/07/2016] [Accepted: 12/22/2016] [Indexed: 12/16/2022]
Abstract
Intravenous immunoglobulin (IVIg) is accepted as an effective and well-tolerated treatment for primary and secondary immunodeficiencies (ID) and immune thrombocytopenia (ITP). Adverse reactions of IVIg are usually mild, comprising transient flu-like symptoms, change in blood pressure and tachycardia. However IVIg therapy can be burdensome for both patients and healthcare facilities, since the infusion may take up to 4h to administer. The objective of our multicentre, prospective, open-label phase III trial was to evaluate the tolerability and safety of human normal immunoglobulin 50g/l (Ig VENA) at high intravenous infusion rates in adult patients with ID and ITP who had previously tolerated IVIg treatment, by progressively increasing infusion rate up to 8ml/kg/hr. 39 ID patients received three infusions, 5 ITP patients received up to a maximum of 5 infusions for a maximum of 5days. Overall 55 adverse events were reported in 18 patients, and all were mild and self-limiting. Two serious adverse events occurred in ID patients and 1 in an ITP patient; none was fatal or treatment-related. No clinically significant changes or abnormalities were observed in vital signs, laboratory results and HRQoL. In summary, in this study, more rapid IVIg infusions were well tolerated by ID and ITP patients, while maintaining their quality of life, helping to minimise the time spent in outpatient hospital visiting to potentially optimise adherence to treatment.
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Affiliation(s)
- Giuseppe Spadaro
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Napoli, Italy.
| | | | | | | | | | - Donatella Lamacchia
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Napoli, Italy
| | - Liliana Nappi
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Napoli, Italy
| | - Antonio Pecoraro
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Napoli, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Rome, Italy
| | | | | | | | | | | | | | - Chiara Guarnieri
- Clinical Development & Operations, Kedrion S.p.A., Castelvecchio Pascoli (Lucca), Italy
| | - Serena Bongiovanni
- Clinical Development & Operations, Kedrion S.p.A., Castelvecchio Pascoli (Lucca), Italy
| | - Isabella Quinti
- Department of Molecular Medicine, "Sapienza" University of Rome, Italy
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