Subcutaneous immunoglobulin therapy by rapid push is preferred to infusion by pump: a retrospective analysis

Abstract

Background: Subcutaneous immunoglobulin (SCIg) replacement therapy for primary immune deficiency disease (PIDD) is a safe, effective, and convenient alternative to intravenous Ig (IVIg) therapy. Although SCIg is typically administered weekly by infusion pump, administration by a rapid push technique may provide a greater degree of convenience. Rapid push administration has been an option at the author's clinic for several years. We report experience with a cohort of patients given a choice between rapid push and standard pump administration.

Methods: This was a retrospective chart review of PIDD patients at a single site who initiated treatment with SCIg (16% solution) therapy between January 1, 2006 and April 1, 2008. Patients selected either infusion pump or rapid push administration after receiving a description and demonstration of each method and training for home self-administration. Demographics, dose, adverse events (AEs), serum immunoglobulin G (IgG) levels, and therapy disposition (discontinued, switched technique) were recorded on a standardized data collection form.

Results: Charts for 104 patients (45 male, 59 female; mean age, 21.1 years; range, 0.5-67.6 years; SD = 17.9 years) were reviewed. Seventy-four patients (71%) chose rapid push. Mean SCIg dose was 32.11 g/month (range, 1.92-89.6 g/month; SD = 8.3 g/month) split into an average of 3.11 times per week. Volume per site ranged from 3 to 20 mL, typically administered over 5-20 min and at one site. Mean serum IgG levels did not differ significantly by administration method: pump, 1,153.06 mg/dL (SD = 240.8); rapid push, 1,225.8 mg/dL (SD = 299.8). Local infusion-site reactions were the most common AEs and were experienced by one third of patients in each group. Only two patients discontinued therapy because of an AE.

Conclusion: The results suggest that PIDD patients prefer SCIg administered as a rapid push rather than as conventional pump infusion. Serum IgG levels were comparable between methods, and safety was similar, if not slightly better, with rapid push. Rapid push offers the potential for even greater convenience than the pump infusion technique, although these results should be confirmed in prospective studies.