A Systematic Review and Meta-regression Analysis on the Impact of Increasing IgG Trough Level on Infection Rates in Primary Immunodeficiency Patients on Intravenous IgG Therapy

Personalized IgG Replacement Therapy for Patients with B cell Inborn Errors of Immunity

“…In a recent issue of the journal, we find a meta-analysis of studies that describe the IgG doses given, serum levels achieved, and the clinical outcomes attained by patients with primary immunodeficiency diseases (PIDD) following treatment with intravenous IgG (IVIG) [1]. This meta-analysis is similar to previously published studies in other journals [2,3].…”

“…Current practice guidelines suggest that "the adequacy of IVIG replacement therapy is determined by the IgG trough (pre-infusion level) at steady state in relation with the patients' clinical course" [4]. However, the optimal serum IgG trough level used as a surrogate marker for IgG efficiency remains unclear [1]. Previous recommendations suggest that IgG trough levels above 500 mg/dL should be sufficient to prevent serious infection [5].…”

Update on Infections in Primary Antibody Deficiencies

“…Serum IgG trough levels, defined as IgG levels just before the next dose, strongly correlate with the dose and interval ( 8 , 156 ). However, some patients with bronchiectasis or chronic lung disease require twice as much IgRT dose to achieve the same IgG trough levels ( 103 , 157 ).…”

“…A meta-analysis showed a progressively reduced number of infections with increasing IgG trough levels from 660 to 960 mg/dL. Beyond this level, the reduction in infection rate was not statistically significant ( 156 ). In another study, a positive correlation between total IgG trough levels and specific anti- pneumococcus and anti- H. influenza IgG levels were observed, and no serious lung infections developed in patients with IgG trough levels ≥700 mg/dL ( 160 ).…”

Antibodies Inhibiting the Type III Secretion System of Gram-Negative Pathogenic Bacteria

“…IVIG contains antibodies with the ability to bind to a wide variety of antigens because it is pooled from so many donors [40,41]. IVIG is often used in immunocompromised patients as a prophylactic to prevent infection [42,43], or in those struggling with active infections [44,45]. If a grouping of non-specific antibodies can help to prevent and treat disease, then antibodies designed specifically to act upon pathogens should be able to do the same at a higher specificity without some of the common side effects and complications of IVIG, such as fever, migraines, anxiety, nausea, and vomiting [46,47].…”