20% subcutaneous immunoglobulin for patients with primary immunodeficiency diseases: A systematic review

Song, Jie; Zhang, Lingli; Li, Youping; Quan, Shuyan; Liang, Yi; Zeng, Linan; Liu, Yi

doi:10.1016/j.intimp.2015.01.016

Cited by 6 publications

(3 citation statements)

References 35 publications

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“…Our study represents the first local analysis of SCIG push in the Manitoba population, and, as far as we know, is the first analysis of SCIG push effectiveness for primary immunodeficiency in Canada. Our study agreed with prior studies showing that SCIG by push prevented infection in a PIDD population, and was well accepted by patients, with a relatively low rate of attrition [1,5,6,10,12,20,25,26]. In our study, SCIG push patients had a statistically significant increase in their serum IgG levels whether they had transitioned from IVIG, or had been started on SCIG push as an initial form of Ig replacement.…”

Section: Discussionsupporting

confidence: 91%

Delivery of subcutaneous immunoglobulin by rapid “push” infusion for primary immunodeficiency patients in Manitoba: a retrospective review

Walter

Kalicinsky

Warrington

et al. 2020

Allergy Asthma Clin Immunol

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Background: Both intravenous and subcutaneous human immune globin G (IgG) replacement (IVIG and SCIG, respectively) reduce severe infection and increase serum IgG levels in primary immune deficiency disorder (PIDD) patients who require replacement. SCIG can be administered either with the aid of an infusion pump, or by patients or caregivers themselves, using butterfly needles and a syringe ("SCIG push"). SCIG offers advantages over IVIG, including higher steady state IgG levels, improved patient quality of life indicators, and decreased cost to the healthcare system, and for these reasons, SCIG has been increasingly used in Manitoba starting in 2007. We sought to determine the effectiveness of SCIG push in our local adult PIDD population. Methods: We conducted a retrospective chart review of all adult patients enrolled in the SCIG push program in Manitoba, Canada from its inception in November 2007 through September 2018. We included patients who were naïve to IgG replacement prior to SCIG, and those who had received IVIG immediately prior. We collected data regarding serum IgG levels, antibiotic prescriptions, hospital admissions, and adverse events during a pre-defined period prior to and following SCIG initiation. Statistical significance was determined via two-tailed t-test. Results: 62 patients met inclusion criteria, of whom 35 were on IVIG prior and 27 were IgG replacement naïve. SCIG push resulted in an increase in serum IgG levels in those naïve to IgG replacement, as well as in those who received IVIG prior. SCIG push also resulted in a statistically significant reduction in number of antibiotic prescriptions filled in the naïve subgroup, and no significant change in antibiotics filled in the IVIG prior group. 8/62 PIDD patients (12.9%) left the SCIG program during our review period for varying reasons, including side-effects. Conclusions: In a real-life setting, in the Manitoba adult PIDD population, SCIG push is an effective method of preventing severe infections, with most patients preferring to continue this therapy once initiated.

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Section: Discussionsupporting

confidence: 91%

Delivery of subcutaneous immunoglobulin by rapid “push” infusion for primary immunodeficiency patients in Manitoba: a retrospective review

Walter

Kalicinsky

Warrington

et al. 2020

Allergy Asthma Clin Immunol

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“…Due to the inclusion and exclusion criteria and propensity score matching process, there were only 45 patients in the intervention group. While the sample size is similar to many other SCIG studies,[82327282930] this limits its power to detect a rare AE and generalizability of the study results. This study did not include new-to-therapy patients; hence, we could not extrapolate our findings to new SCIG users.…”

Section: Discussionmentioning

confidence: 99%

Outcome evaluation of a subcutaneous immunoglobulin clinical management program

et al. 2019

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Objective: The aim of this study is to compare clinical and cost outcomes of patients undergoing subcutaneous immunoglobulin (SCIG) therapy who were managed by a clinical management program to the matched controls in the United States. Methods: This was a retrospective cohort study using administrative claims data from the PharMetrics Plus™ (PMTX+) database. The patients from a high-touch SCIG clinical management program were matched to nonprogram patients in PMTX+ database using 1:4 propensity score matching without replacement. All patients were followed for 1 year during the study from September 1, 2011, to June 30, 2014, and both clinical and cost outcomes were compared between the two cohorts using the generalized estimating equation model. Findings: The clinical outcomes were measured by infection- and infusion-related adverse events (AEs). Most of them were not significantly different ( P > 0.05) between the intervention group and matched controls. Although the proportion of patients who had a mild less common AE was higher (4.4% vs. 0.0%;P = 0.04), it could be due to increased reporting among the intervention group. The annual adjusted mean total health-care costs of patients in the program ( n = 45) were $20,868 lower compared to matched controls ( n = 180), representing a 24% lower costs ($66,450 vs. $87,318;P = 0.009). Conclusion: This study may demonstrate that clinical management programs for SCIG may be associated with lower health-care costs and comparable infection and severe AE rates. The limitations of this study included a small sample size and a reliance on administrative claim data.

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“…(GRADE A1) 7,15,50,51 R En las inmunodeficiencias primarias se administra 100 a 200 mg/kg de inmunoglobulina subcutánea por semana o 200 a 400 mg/kg cada 2 semanas. (GRADE A1) 15,43,45,52 R La misma dosis mensual de reemplazo que se utiliza con la IgIV se puede utilizar con la modalidad subcutánea, dividida en 4 o 2 semanas. (GRADE A1) 53 R En pacientes con terapia de reemplazo con inmunoglobulina subcutánea se recomienda iniciar con una velocidad de infusión de 10 a 40 mL/h, con un volumen máximo por sitio de aplicación de 20 mL en niños; en adultos son bien tolerados hasta 30 mL.…”

Section: Dosis De Inmunoglobulinaunclassified

Guía colombiana de práctica clínica para el uso de inmonuglobulinas en el tratamiento de reemplazo e inmunomodulación

Olivares

Olmos²,

Álvarez

et al. 2017

RAM

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Immunoglobulins are heterodimeric proteins composed of 2 heavy chains and 2 light chains. Human immunoglobulin G (IgG) is a plasma derivative and contains more than 95% of IgG. The composition of IgG subclasses is similar to that of normal human plasma. Immunoglobulin therapy was first introduced more than 50 years ago, and its use has been described in numerous diseases. In Colombia, the importance of this immunomodulatory resource prompted the need for clinical practice guidelines to be available for its use. For this reason, a multidisciplinary group of experts was brought together and distributed in working groups, by specialties, in order to develop an initial manuscript. Systematic literature searches were undertaken; identified evidences were evaluated and classified to support a preliminary draft that was discussed, analyzed and amended. Recommendations were issued on the use of intravenous immunoglobulin in pathologies that include primary and secondary immunodeficiencies, autoimmune diseases, neurological disorders, infections, transplants and miscellaneous conditions; grades were assigned to each one of them according to the GRADE system. The final result translated into recommendations that are put forth with the purpose to inform, guide and support on optimal use of this immunomodulatory resource.

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20% subcutaneous immunoglobulin for patients with primary immunodeficiency diseases: A systematic review

Cited by 6 publications

References 35 publications

Delivery of subcutaneous immunoglobulin by rapid “push” infusion for primary immunodeficiency patients in Manitoba: a retrospective review

Delivery of subcutaneous immunoglobulin by rapid “push” infusion for primary immunodeficiency patients in Manitoba: a retrospective review

Outcome evaluation of a subcutaneous immunoglobulin clinical management program

Guía colombiana de práctica clínica para el uso de inmonuglobulinas en el tratamiento de reemplazo e inmunomodulación

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