Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for Neurological Patients

Abstract

BackgroundSubcutaneous immunoglobulin (SCIg) treatment has been shown to control symptoms and improve overall satisfaction in patients with neurological disorders. However, a large injection volume can be overwhelming and a barrier to successful SCIg treatment. We established a nurse-led individualized approach program to facilitate a smooth and successful treatment transition from intravenous immunoglobulin (IVIg) to SCIg. The program involved a lead nurse to provide two or more individual educational sessions on SCIg administration, establish a written transition plan, and liaise care with physicians.ObjectivesWe aimed to evaluate the impact of our program to a successful transition defined as SCIg retention or adherence without a need to restart IVIg by six or twelve months.MethodsWe reviewed medical charts of all patients with immune-mediated neuromuscular disorders who were in our program during January 2010 to Dec 2016.ResultsNineteen patients were identified. Mean IVIg treatment duration was 31.5 months (range 4-98) before the transition. Mean steady state SCIg dosage was 26.2 g/week (SD 10.3). All patients were initially able to switch to SCIg, with a retention rate of 17/19 (89.5%) at six months and 15/19 (78.9%) at twelve months. Two patients reverted back to IVIg treatment due to worsening of their symptoms at two and three months, while two required supplemental IVIg infusions. There were no major adverse events reported during the twelve-month period, but one minor cutaneous adverse event (redness around the injection site).ConclusionsSuccessful treatment transition may be achieved with the nurse led individualized approach program.

Subcutaneous immunoglobulin treatment for chronic inflammatory demyelinating polyneuropathy

“…37 A support program for patients opting to transition to SCIg is important to build confidence with selfadministration for successful long-term adherence. 64 In one study, a 20 Van Schaik et al reported that the rate of headaches was low for SCIg (7%) and this was maintained during the OLE study (5%). 16,33 In comparison, headaches associated with IVIg have been reported in other studies as ranging between 32% and 62% of patients.…”

“… 37 A support program for patients opting to transition to SCIg is important to build confidence with self‐administration for successful long‐term adherence. 64 In one study, a nurse‐led individualized program that included teaching sessions, written materials, and a clear care plan helped to successfully transition patients with neurological disorders from IVIg to SCIg. In this study, SCIg retention rates were 90% (n = 17/19) at 6 mo and 79% (n = 15/19) at 12 mo.…”

“…In this study, SCIg retention rates were 90% (n = 17/19) at 6 mo and 79% (n = 15/19) at 12 mo. 64 It is important to highlight to patients the importance of treatment adherence to maintain therapeutic IgG concentrations and to keep accurate records of each infusion. Nurses and pharmacists are also important in providing a continued touchpoint for patient support.…”

Through the Skin, To the Nerves: Subcutaneous Immunoglobulin for Neuromuscular Diseases

“…In this issue of the Canadian Journal of Neurological Sciences, Suleman et al describe a multi-disciplinary approach to subcutaneous immunoglobulin (SCIG) administration in patients with immune neurological conditions in the article "Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for a Neurological Patients". 1 In their study, a nurse-led program transitioned patients receiving 10% intravenous immunoglobulin (IVIG) to 20% SCIG using a conversion of 1:1.2 (IVIG:SCIG), with a 79% retention rate at 12 months, no serious adverse events and only one minor cutaneous dermatological adverse event reported. In their study, which included patients with chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy (MMN), myasthenia gravis (MG) or Lambert Eaton Myasthenic Syndrome, four patients (three with MMN) were not able to complete the 12 months of SCIG treatment and required either supplemental IVIG infusions or a transition back to IVIG treatment.…”

“…In this issue of the Canadian Journal of Neurological Sciences, Suleman et al describe a multi-disciplinary approach to subcutaneous immunoglobulin (SCIG) administration in patients with immune neurological conditions in the article “Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for a Neurological Patients” 1 . In their study, a nurse-led program transitioned patients receiving 10% intravenous immunoglobulin (IVIG) to 20% SCIG using a conversion of 1:1.2 (IVIG:SCIG), with a 79% retention rate at 12 months, no serious adverse events and only one minor cutaneous dermatological adverse event reported.…”