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Flexible Subcutaneous Immunoglobulin G Dosing in Primary Immunodeficiency - Quality of Life Outcomes
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Claire Jones, Sadia Noorani, MD
Rationale: Many patients with primary immunodeficiency (PID) are choosing to switch from hospital-based intravenous immunoglobulin (IVIg) to home-based subcutaneous immunoglobulin (SCIg) treatment or from SCIg-fortnightly (every second week) to flexible SCIg-manual push. SCIg avoids the wear-off and systemic side effects associated with IVIg and is thought to improve patients’ quality of life (QoL).

Methods: PID patients were switched from 3-weekly IVIg to SCIg-fortnightly (n=1) or SCIg-manual push (n=2), or from SCIg-fortnightly to SCIg-manual push (n=1). Pre- and post-switch, patients completed treatment satisfaction questionnaires, the SF-36 and had immunoglobulin G (IgG), white cell count (WCC) and C-reactive protein (CRP) levels measured. Other patients are currently switching to SCIg-manual push.

Results: Pre-switch, patients were 100% satisfied with their treatment, rated their general health as ‘good’ to ‘excellent’, and reported side effects in 11–64% of IVIg infusions (mostly headache/fatigue). Reasons for switching included ‘convenience’ and ‘home-therapy’. Post-switch, IgG levels were ≥9.8 g/L, WCC levels were 4.7–7.7 x109/L and CRP levels were <1–6 mg/L. Patients reported: 100% treatment satisfaction; side effects in up to 50% of SCIg infusions (mostly local reactions); general health as ‘good’ to ‘excellent’; and SCIg training as ‘very good’. SCIg-manual push infusion duration was rated ‘very convenient’ with no treatment wear-off effects. The switch met each patient’s expectations and no patients wish to switch back to their previous therapy.

Conclusions: Post-switch data in patients with PID show SCIg to enhance patients’ QoL versus IVIg due to fewer side effects and the convenience of home-therapy.