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Mathias N, Huille S, Picci M, Mahoney RP, Pettis RJ, Case B, Helk B, Kang D, Shah R, Ma J, Bhattacharya D, Krishnamachari Y, Doucet D, Maksimovikj N, Babaee S, Garidel P, Esfandiary R, Gandhi R. Towards more tolerable subcutaneous administration: Review of contributing factors for improving combination product design. Adv Drug Deliv Rev 2024; 209:115301. [PMID: 38570141 DOI: 10.1016/j.addr.2024.115301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
Subcutaneous (SC) injections can be associated with local pain and discomfort that is subjective and may affect treatment adherence and overall patient experience. With innovations increasingly focused on finding ways to deliver higher doses and volumes (≥2 mL), there is a need to better understand the multiple intertwined factors that influence pain upon SC injection. As a priority for the SC Drug Development & Delivery Consortium, this manuscript provides a comprehensive review of known attributes from published literature that contribute to pain/discomfort upon SC injection from three perspectives: (1) device and delivery factors that cause physical pain, (2) formulation factors that trigger pain responses, and (3) human factors impacting pain perception. Leveraging the Consortium's collective expertise, we provide an assessment of the comparative and interdependent factors likely to impact SC injection pain. In addition, we offer expert insights and future perspectives to fill identified gaps in knowledge to help advance the development of patient-centric and well tolerated high-dose/high-volume SC drug delivery solutions.
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Affiliation(s)
- Neil Mathias
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
| | - Sylvain Huille
- Sanofi, 13 quai Jules Guesde, 94400 Vitry-Sur-Seine, France.
| | - Marie Picci
- Novartis Pharma AG, Fabrikstrasse 4, CH-4056 Basel, Switzerland
| | - Robert P Mahoney
- Comera Life Sciences, 12 Gill St, Suite 4650, Woburn, MA 01801 USA
| | - Ronald J Pettis
- Becton-Dickinson, 21 Davis Drive, Research Triangle Park, NC 27513 USA
| | - Brian Case
- KORU Medical Systems, 100 Corporate Dr, Mahwah, NJ 07430 USA
| | - Bernhard Helk
- Novartis Pharma AG, Werk Klybeck, WKL-681.4.42, CH-4057 Basel, Switzerland
| | - David Kang
- Halozyme Therapeutics, Inc., 12390 El Camino Real, San Diego, CA 92130 USA
| | - Ronak Shah
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
| | - Junchi Ma
- Johnson & Johnson Innovative Medicine, 200 Great Valley Pkwy, Malvern, PA 19355 USA
| | | | | | - Dany Doucet
- GSK, 1250 South Collegeville Road, Collegeville, PA 19426 USA
| | | | - Sahab Babaee
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065 USA
| | - Patrick Garidel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Straße 65, 88397 Biberach/Riss, Germany
| | | | - Rajesh Gandhi
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
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Sil A, Basu S, Joshi V, Pilania RK, Siniah S, Suri D, Rawat A, Singh S. Immunoglobulin replacement therapies in inborn errors of immunity: a review. Front Pediatr 2024; 12:1368755. [PMID: 38425666 PMCID: PMC10902166 DOI: 10.3389/fped.2024.1368755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Immunoglobulins (Ig) were used as a therapeutic modality for the first time in a patient with X-linked agammaglobulinemia in 1952 by Colonel Ogden Bruton, decades before the molecular mechanisms causing the disease were unraveled. In many autoimmune and inflammatory illnesses, human immunoglobulin has been employed as a significant immunomodulatory and immunosuppressive drug. In patients with inborn errors of immunity (IEI), immunoglobulin remains a cornerstone of management. IEIs are notable causes of recurrent infections and autoimmunity due to inheritable single-gene defects in genes encoding for different components of the immune system. As there is decreased immunoglobulin production in IEIs with antibody defects, immunoglobulin replacement is the mainstay of therapy in these disorders. Although serum immunoglobulin levels may not be low in combined immune defects, immunoglobulin replacement is still necessary in these disorders due to a deficiency of functional antibodies and qualitative defects of immunoglobulins. Commercial immunoglobulin preparations are generated from plasma donated by thousands of donors. Immunoglobulin preparations are usually available in two forms: intravenous and subcutaneous immunoglobulins. In the developed world, both intravenous immunoglobulin (IVIg) and subcutaneous immunoglobulin (SCIg) are available, and SCIg is preferred over IVIg for replacement therapy in patients with IEIs. In developing countries, IVIg remains the mainstay of replacement therapy. The rate of adverse events has significantly reduced over the last few years due to advancements in the production process. In this review article, we discuss different aspects of the use of Ig (indications, dosing, mechanism of action, route, adverse effects) in patients with IEIs.
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Affiliation(s)
| | | | | | - Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Boyle T, Zaragoza R, Li J, Cvetanovski V, Weaver P, Hoyle P, Venkatesha V, Fernando SL. A retrospective review of immunology patients with primary and/or secondary immunodeficiency, demonstrating the benefits of the rapid transitioning from intravenous immunoglobulin to subcutaneous immunoglobulin at the onset of the COVID-19 pandemic. Intern Med J 2023; 53:1256-1260. [PMID: 37092797 DOI: 10.1111/imj.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
Forty-four of 50 immunology patients with primary or secondary immunodeficiency receiving intravenous immunoglobulin at a hospital in New South Wales, Australia, were rapidly enrolled in the subcutaneous immunoglobulin (SCIg) programme at the onset of the 2020 COVID-19 pandemic. Health and economic outcomes demonstrated that SCIg provides clinical efficacy as evidenced by the number of infections and maintenance of IgG levels, and also facilitates cost reduction in immunoglobulin maintenance programmes.
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Affiliation(s)
- Therese Boyle
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Immunology Laboratory, Level 5, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Reina Zaragoza
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jamma Li
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Immunology Laboratory, Level 5, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Vera Cvetanovski
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Phillippa Weaver
- Patient Safety and Quality Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Philip Hoyle
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Services, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Suran L Fernando
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Immunology Laboratory, Level 5, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Lutz C, Feiten S, Chakupurakal G, Heymanns J, Thomalla J, van Roye C, Weide R. Patients with indolent lymphomas are at high risk of infections: experience from a German outpatient clinic. BMC Immunol 2023; 24:2. [PMID: 36631764 PMCID: PMC9833869 DOI: 10.1186/s12865-022-00536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patients with indolent B-cell non-Hodgkin lymphomas (B-NHLs) have an increased risk of infections which is caused by pathomechanisms of the diseases itself but also as a result of anti-tumor therapy. Especially the effects of anti-CD20 antibodies are well understood as these lead to decreased antibody production. Most studies regarding immunodeficiency in B-NHLs were conducted with multiple myeloma and chronic lymphocytic leukemia patients. As these studies not always represent the general population we collected and analyzed real world data from patients with indolent lymphomas and a control group (CG). RESULTS Patients with B-NHLs undergoing therapy or who were regularly monitored in a watch and wait approach had, over the time of one year, an increased rate of infections compared to the CG of 145 healthy volunteers (mean: 11.66 vs. 7.13 infections per 1000 days). Consistent with this finding B-NHL patients received more antibiotic treatment (mean: 11.17 vs. 6.27 days) and were more often hospitalized than persons from the CG (mean: 5.19 vs. 0.99 days per 1000 days). Lymphoma patients without immunodeficiency had a lower infection rate than patients with non-symptomatic and symptomatic immunodeficiency (mean: 10.91 vs. 12.07 and 12.36 per 1000 days). The number of infections differed statistically significant for the subgroups and CG (7.13 per 1000 days). Patients with symptomatic immunodeficiency were mostly treated with regular immunoglobulin substitutions and infection rates were comparable to those of patients with asymptomatic immunodeficiency. CONCLUSIONS Our data suggest the use of an approach with regular immune monitoring including the measurement of immunoglobulin levels and regular appointments for clinical assessment of all indolent lymphoma patients in order to identify patients with increased risk of infections. It also raises the question if patients with immunodeficiency should be treated more often with regular immunoglobulin substitution, but so far more studies are necessary to answer this question.
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Affiliation(s)
- Christoph Lutz
- Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068, Koblenz, Germany.
| | - Stefan Feiten
- grid.488965.eInstitut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | - Geothy Chakupurakal
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
| | - Jochen Heymanns
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
| | - Jörg Thomalla
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
| | - Christoph van Roye
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
| | - Rudolf Weide
- grid.477753.50000 0004 0560 2414Praxis für Hämatologie und Onkologie Koblenz, Neversstr. 5, 56068 Koblenz, Germany
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Coyle L. Celebrating the 15th anniversary of Immunotherapy: a reflection on 2022. Immunotherapy 2023; 15:1-4. [PMID: 36700701 DOI: 10.2217/imt-2022-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Lauren Coyle
- Commissioning Editor, Future Science Group, Unitec House, 2 Albert Place, N3 1QB, London, UK
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Kobayashi RH, Litzman J, Melamed I, Mandujano JF, Kobayashi AL, Ritchie B, Geng B, Atkinson TP, Rehman S, Höller S, Turpel-Kantor E, Kreuwel H, Speer JC, Gupta S. Long-term efficacy, safety, and tolerability of a subcutaneous immunoglobulin 16.5% (cutaquig®) in the treatment of patients with primary immunodeficiencies. Clin Exp Immunol 2022; 210:91-103. [PMID: 36208448 PMCID: PMC9750824 DOI: 10.1093/cei/uxac092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/30/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023] Open
Abstract
A prospective study and its long-term extension examined whether weekly treatment of patients with primary immunodeficiencies (PIDs) with a 16.5% subcutaneous immunoglobulin (SCIg; cutaquig®) confers acceptable efficacy, safety, and tolerability over a follow-up of up to 238 weeks (>4 years). Seventy-five patients received 4462 infusions during up to 70 weeks of follow-up in the main study and 27 patients received 2777 infusions during up to 168 weeks of follow-up in the extension. In the main study, there were no serious bacterial infections (SBIs), and the annual rate of other infections was 3.3 (95% CI 2.4, 4.5). One SBI was recorded in the extension, for an SBI rate of 0.02 (upper 99% CI 0.19). The annual rate of all infections over the duration of the extension study was 2.2 (95% CI 1.2, 3.9). Only 15.0% (1085) of 7239 infusions were associated with infusion site reactions (ISRs), leaving 85.0% (6153) of infusions without reactions. The majority of ISRs were mild and transient. ISR incidence decreased over time, from 36.9% to 16% during the main study and from 9% to 2.3% during the extension. The incidence of related systemic adverse events was 14.7% in the main study and 7.4% in the extension. In conclusion, this prospective, long-term study with cutaquig showed maintained efficacy and low rates of local and systemic adverse reactions in PID patients over up to 238 weeks of follow-up.
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Affiliation(s)
| | - Jiří Litzman
- Department of Clinical Immunology and Allergology, St Anne’s University Hospital in Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | | | | | - Bruce Ritchie
- Division of Hematology, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Bob Geng
- Divisions of Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
| | - T Prescott Atkinson
- Department of Pediatric Allergy, Asthma and Immunology, University of Alabama, Birmingham, AL, USA
| | - Syed Rehman
- Allergy and Asthma Center Inc., Toledo, OH, USA
| | - Sonja Höller
- Octapharma Pharmazeutika Produktionsges.m.b.H., Vienna, Austria
| | | | | | | | - Sudhir Gupta
- Division of Basic and Clinical Immunology, University of California Irvine, Irvine, CA, USA
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Kim SH, Yoo HJ, Park EJ, Lee W, Na DH. Impact of buffer concentration on the thermal stability of immunoglobulin G. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2022. [DOI: 10.1007/s40005-022-00587-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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