1040 Prophylactic infusions with an unmodified intravenous immunoglobulin product causing few side-effects in patients with antibody deficiency syndromes

Abstract

Thirty-two patients with common variable immunodeficiency (CVID) and two patients with IgA and IgG subclass deficiency received a total of 1,040 intravenous (i.v.) infusions during 60 patient years with 7,575 g of a new immunoglobulin (Ig) preparation. The content of prekallikrein activators and the anti-complementary activity in the tested Ig preparation was low and, in comparison to seven other commercial i.v. Igs, so was the proportion of IgG polymers and fragments. The IgA content was always less than or equal to 0.02 g/l, often less than 0.004 g/l, and it was possible to continuously give the Ig prophylactically to four patients with anti-IgA antibodies, i.e. three with CVID and one with combined IgA-IgG2 deficiency. Adverse reactions were only noted in 4.7% of the 1,040 infusions and in 12 out of the 34 patients. None of the reactions were of the anaphylactic type, but two patients had moderate reactions and one had anuria, probably not caused by the Ig. A simultaneous infection seemed to increase the risk of phlogistic reactions, as five out of six patients who reacted with temperature rise and chills had a simultaneous upper respiratory tract infection. A substudy of various dosage schedules was performed with 11 patients receiving 203 infusions over 10.8 patient years. On 25 mg/kg/week of Ig given i.v. every five weeks, a mean increase in the preinfusion serum IgG level of 0.3 g/l was observed, as compared to earlier i.m. prophylaxis with the same dose. Only 1/4 of the patients on 25 mg/kg/week every five or three weeks reached a preinfusion IgG level greater than or equal to 3 g/l.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of anti-IgA antibodies in causing adverse reactions to gamma globulin infusion in immunodeficient patients: A comprehensive review of the literature

“…A few studies have focused on patients with anti-IgA who tolerated gamma globulin. 14,17,25,34,35 We have found reports of a total of 49 IgA-deficient patients with IgG anti-IgA who tolerated gamma globulin. The IgA level was less than 7 mg/dL in 37 (76%) of the patients; the level was not stated for 12 others.…”

The life situations of patients with primary antibody deficiency untreated or treated with subcutaneous gammaglobulin infusions

“…For many years, this lifelong replacement therapy was given in the form of intramuscular injections or plasma infusions. During the 1980s, suitable intravenous preparations were developed, and this form of administration was frequently used [3][4][5][6][7][8][9], but was subsequently replaced in our clinic by subcutaneous infusions of an intramuscular gammaglobulin preparation [10].…”

A review on guidelines for management and treatment of common variable immunodeficiency

“…IgG replacement is the mainstay of treatment of CVID [35] and it has been shown that long-term Ig replacement therapy for CVID has reduced the rate of infections and their long-term complications [38][39][40][41]. However, despite the reduction in the rate of bacterial infections by use of IgG replacement in CVID patients, these patients are still more susceptible to complications because of a dysregulated immune response that attracts the caregiver's attention.…”