623:
Impact of IVIG vs. SCIG on IgG trough level and infection rates in Primary Immunodeficiency diseases: A systematic review and meta-analysis of 1,426 patients
Sunday, February 24, 2019: 4:30 PM
Lobby Level (Moscone Center South)
Pragya Shrestha, MD, Zhen Wang, PhD, Paras Karmacharya, MD, Anthony Donato, MD, MHPE, Avni Y. Joshi, MD, MSc
Rationale:

IVIG (Intravenous Immunoglobulin) and SCIG (Subcutaneous Immunoglobulin) have been regarded as therapeutically equivalent treatments for primary immunodeficiency diseases (PIDDs). IgG trough level is used as a monitoring measure for infection prevention. A systematic review and meta-analysis was performed in patients with PIDD and relationship between IgG dosing, trough IgG levels with overall infection incidence were evaluated.

Methods:

Medline, EMBASE, Cochrane, Central and Scopus were searched for studies published from Jan 2000- June 2018, fulfilling the inclusion criteria. DerSimonian and Laird random-effect method was used to pool difference of IgG trough levels. Random-effect meta-regression was used to evaluate infection incidence per 100 mg/dl IgG trough increase through IVIG and SCIG.

Results:

Out of 24 observational studies included (1,426 patients), 11 compared IgG trough levels among SCIG and IVIG (mean difference: 73.4 mg/dl, 95% CI: 31.67-119.19 mg/dl, I2= 45%, p=0.05), favoring SCIG. For every 100 mg/dl increase in trough, a linear trend of decreased incidence rates of infection was identified in SCIG patients (p=0.03), but no similar trend was identified in trough levels vs. infection rates for patients receiving IVIG (p=0.67).

Conclusions:

SCIG is associated with a higher IgG trough level in comparison to IVIG. Higher SCIG troughs were associated with lower infection rates, while IVIG troughs demonstrated no relationship.