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What is the Future of Pain Research? Return to page one of SubQ IVIG

Subcutaneous Infusion leads to a improved IgG level.

Above slides from Melvin Berger MD Case Western Reserve University

Subcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: safety and costs.

Gardulf A, Andersen V, Bjorkander J, Ericson D, Froland SS, Gustafson R, Hammarstrom L, Jacobsen MB, Jonsson E, Moller G, et al.

Department of Clinical Immunology, Karolinska Institute, Huddinge University Hospital, Sweden.

Immunoglobulins (IgG) as replacement therapy in primary antibody deficiencies can be given as intramuscular injections, or as intravenous or subcutaneous infusions. Our aims were to obtain information on the frequency of adverse systemic reactions during subcutaneous therapy, the occurrence and intensity of tissue reactions at the infusion sites, and serum IgG changes. Furthermore, we compared costs between the different replacement regimes. Our study included 165 patients (69 women, 96 men, aged 13-76 years) with primary hypogammaglobulinaemia or IgG-subclass deficiencies. Data were compiled from questionnaires filled in by the patients and from their medical records. 33,168 subcutaneous infusions (27,030 in home therapy) had been given. 106 (of which 16 were at home) adverse systemic reactions (100 mild, 6 moderate) were recorded in 28 patients (17%). No severe or anaphylactoid reactions occurred. Despite large immunoglobulin volumes given during 434 patient years (28,480 infusions), no signs have been found that indicate the transmission of hepatitis virus. Transient tissue reactions occurred at the infusion sites but were not troublesome to most patients and we found significant increases in mean serum IgG. The use of subcutaneous instead of intravenous infusions at home would reduce the yearly cost per patient for the health-care sector by US $10,100 in Sweden alone.
We conclude that subcutaneous administration of IgG is a safe and convenient method of providing immunoglobulins. We were able to reach serum IgG concentrations similar to those by the intravenous therapy and we found that the method could also be used successfully in patients with previous severe or anaphylactoid reactions to intramuscular injections.

J Gaspar, B Gerritsen, A Jones

Department of Immunology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK

Correspondence to: J Gaspar or A Jones.
Accepted 7 January 1998

Long term intravenous immunoglobulin (IVIG) infusion is an effective treatment for children with immunodeficiencies, but can be complicated by poor venous access, systemic adverse reactions, and the need for frequent hospital admission. Rapid subcutaneous immunoglobulin (SCIG) infusion has been found to be effective in adults with primary immunodeficiency. Twenty six children were treated with SCIG for a median period of two years (range six months to 3.5 years). Fifteen children had previously been treated with IVIG. Retrospective analysis showed that trough IgG concentrations while receiving SCIG were comparable with those while receiving IVIG during maintenance treatment. In severe hypogammaglobulinaemia, however, initial loading with SCIG or IVIG is probably indicated. During the treatment period there was no systemic adverse reaction nor severe reaction requiring admission to hospital. The subjective impression of all families was a significant improvement in the quality of life. This preliminary experience with SCIG in children suggests that it is an effective, convenient, and well tolerated alternative to intravenous treatment. Larger prospective studies are required to determine the place of SCIG in the management of immunodeficiencies.

Keywords: immunoglobulin; subcutaneous infusion; immunodeficiency