Switch from intravenous to subcutaneous immunoglobulin in CIDP and MMN: improved tolerability and patient satisfaction

Hadden, Robert D.M.; Marreno, Fabrizio

doi:10.1177/1756285614563056

Cited by 63 publications

(79 citation statements)

References 11 publications

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“…Second, subcutaneous immunoglobulin (SCIG) may be an alternative [18,19]. Hadden et al briefly described the occurrence of IVIG-induced neutropenia in three patients with MMNCB, which resolved after switching to SCIG [20]. We have not been able to administer SCIG in our case because it is not available in Korea.…”

Section: Discussionmentioning

confidence: 64%

Neutropenia Following Intravenous Immunoglobulin Administration in a Patient with Multifocal Motor Neuropathy with Conduction Block

Sohn¹,

Kim²

2017

J Neurol Neurophysiol

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Intravenous immunoglobulin (IVIG) is the treatment of choice in patients with multifocal motor neuropathy with conduction block (MMNCB). Although IVIG is considered generally safe, neutropenia following IVIG infusion has been recognized as a rare hematologic side effect. Herein we report a patient with MMNCB who developed severe neutropenia following IVIG administration.A 41 year old woman presented with progressive weakness of her left lower extremity with frequent muscle cramps. Nerve conduction study revealed marked conduction blocks on right ulnar and right tibial nerves. Serum IgM anti-GM1 antibody was detected. Neutrophil count decreased from day 2 and recovered after 2 weeks following IVIG infusion. To our knowledge, neutropenia following IVIG infusion in MMNCB has never been discussed apart, although it can be an important clinical issue especially for patients with MMNCB.

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Section: Discussionmentioning

confidence: 64%

Neutropenia Following Intravenous Immunoglobulin Administration in a Patient with Multifocal Motor Neuropathy with Conduction Block

Sohn¹,

Kim²

2017

J Neurol Neurophysiol

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“…Recent research into applications of SCIg in non-primary immunodeficiencies has focused primarily on CIPD and inflammatory myopathies (polymyositis, dermatomyositis) in adults [90][91][92]. Preliminary studies in small numbers of patients in primarily European studies suggest improved tolerability, patient satisfaction, and cost in the disease stabilization period of these disorders [90,[93][94][95], although long-term efficacy and randomized controlled studies are unavailable, and these studies were performed in patients who received SCIg after IVIG. Moreover, there are speculative theoretical advantages of achieving peak IgG levels via IVIG in the acute phase of diseases like KD and ITP, and IVIG has been proposed to primarily target the humoral immune component whereas SCIg is postulated to better target the cellular component of the immune modulatory response [91].…”

Section: Role Of Subcutaneous Immunoglobulin (Scig)mentioning

confidence: 96%

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

Wong

White

2015

Clinic Rev Allerg Immunol

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Intravenous immunoglobulin (IVIG) provides replacement therapy in immunodeficiency and immunomodulatory therapy in inflammatory and autoimmune diseases. This paper describes the immune mechanisms underlying six major non-primary immunodeficiency pediatric diseases and the diverse immunomodulatory functions of IVIG therapy. In Kawasaki disease, IVIG plays a major, proven, and effective role in decreasing aneurysm formation, which represents an aberrant inflammatory response to an infectious trigger in a genetically predisposed individual. In immune thrombocytopenia, IVIG targets the underlying increased platelet destruction and decreased platelet production. Although theoretically promising, IVIG shows no clear clinical benefit in the prophylaxis and treatment of neonatal sepsis. Limitations in research design combined with the unique neonatal immunologic environment offer explanations for this finding. Inflammation from aberrant immune activation underlies the myelinotoxic effects of Guillain-Barré syndrome. HIV-1 exerts a broad range of immunologic effects and was found to decrease serious bacterial infections in the pre-highly active anti-retroviral therapy (HAART) era, although its practical relevance in the post-HAART era has waned. Clinical and experimental data support the role of immune mechanisms in the pathogenesis of childhood epilepsy. IVIG exerts anti-epileptic effects through targeting upregulated cytokine pathways and antibodies thought to contribute to epilepsy. Applications in six additional pediatric diseases including pediatric asthma, atopic dermatitis, cystic fibrosis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS), autism, and transplantation will also be briefly reviewed. From autoimmunity to immunodeficiency, a dynamic immunologic basis underlies major pediatric diseases and highlights the broad potential of IVIG therapy.

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“…The treatment improves tolerability among patients who had experienced systemic reactions to IVIG 7,12 and can be administered at home, resulting not only in greater convenience to the family and the patient, but also reducing the number of missed school days. In addition, SCIG may reduce the cost of therapy up to 33%.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Immunoglobulin in Refractory Juvenile Dermatomyositis

et al. 2016

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Juvenile dermatomyositis (JDM) is the most common form of juvenile idiopathic inflammatory myopathy. We report a child with steroid-dependent JDM refractory to hydroxychloroquine and subcutaneous methotrexate who experienced systemic reactions to intravenous immunoglobulin and was successfully treated with subcutaneous immunoglobulin. This form of therapy has been shown to be safe, has a very low rate of adverse effects, does not require hospital admission, reduces the number of missed school days, and decreases the costs associated with treatment.

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Switch from intravenous to subcutaneous immunoglobulin in CIDP and MMN: improved tolerability and patient satisfaction

Cited by 63 publications

References 11 publications

Neutropenia Following Intravenous Immunoglobulin Administration in a Patient with Multifocal Motor Neuropathy with Conduction Block

Neutropenia Following Intravenous Immunoglobulin Administration in a Patient with Multifocal Motor Neuropathy with Conduction Block

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

Subcutaneous Immunoglobulin in Refractory Juvenile Dermatomyositis

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