Subcutaneous immunoglobulins in the treatment of chronic immune-mediated neuropathies

Abstract

Abstract:Intravenous immunoglobulins represent an established therapy for the treatment of chronic immune-mediated neuropathies, specifically chronic inflammatory demyelinating polyradiculoneuropathies (CIDPs) as well as multifocal motor neuropathies (MMNs). For the treatment of antibody deficiency syndromes, subcutaneous immunoglobulins (SCIgs) have represented a mainstay for decades. An emerging body of evidence suggests that SCIg might also exhibit clinical efficacy in CIDP and MMN. This article reviews the current evidence for clinical effectiveness, as well as safety of SCIg for the treatment of immune-mediated neuropathies, and addresses remaining open questions in this context. We conclude that despite the need for controlled long-term studies to demonstrate long-term efficacy of SCIg in immune-mediated neuropathies, SCIg may already represent a potential therapeutic alternative for selected patients.

Aktuelle Therapie von Immunneuropathien

“…Beim Umsetzen sollte zunächst eine der intravenösen Gabe äquivalente Dosis appliziert werden. Weitere Langzeituntersuchungen zum Einsatz von SCIG bei MMN sind jedoch noch erforderlich [57]. Evidenzklasse: II; Empfehlungsklasse: B.…”

“…Es besteht weiterhin Bedarf an kon trollierten Studien, die eine Langzeitwirksamkeit von SCIG bei der CIDP demonstrieren. Dabei gilt es die optimale Dosierung zu definieren[57].…”

Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for Neurological Patients

“…1 Subcutaneous immunoglobulin (SCIg) has gained popularity as it is a less invasive procedure and can be selfadministered at home for both patients with primary and secondary immunodeficiency and immune-mediated neurological disorders. 2,3 A recent systematic review and meta-analysis confirmed that SCIg treatment was as effective as IVIg treatment in patients with primary immunodeficiency, and had fewer associated side-effects. 4 Our group previously reported that SCIg was an effective adjunctive therapy for the chronic management of myasthenia gravis (MG), identified by high patient satisfaction on several assessment scales.…”

“…5 Many studies also suggested SCIg as a viable alternative to IVIg in the management of chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). 3,[6][7][8] SCIg is also recently approved to be used as maintenance therapy to prevent relapse of neuromuscular disability and impairment in patients with CIDP following the PATH study. 8 Research has shown that patients can be effectively switched from IVIg to SCIg without deterioration in their symptoms.…”

Therapien bei der chronisch inflammatorischen demyelinisierenden Polyneuropathie

“…Die subkutane Verabreichung von Immunglobulinen wird auch von Patientenseite oft gegenüber der intravenösen Applikation bevorzugt, da eine höhere Patientenautonomie mit Vermeidung von Krankenhausaufenthalten und damit insgesamt eine verbesserte Lebensqualität besteht[17,20]. Die Sicherheit, Umsetzbarkeit und klinische Effektivität der subkutanen Immunglobulintherapie bei Patienten mit CIDP wurde in mehreren Fallserien und Studien gezeigt[17,[19][20][21][22][23][24]. In der bisher größten randomisierten Phase-III-Studie erhielten 172 Patienten mit CIDP, welche unter IVIG-Therapie einen stabilen klinischen Zustand erreicht hatten, Placebo oder SCIG in einer Dosis von entweder 0,2 g/kg KG oder 0,4 g/kg KG wöchentlich über 24 Wochen[4].…”