Facilitated Subcutaneous Immunoglobulin Replacement Therapy in Clinical Practice: A Two Center, Long-Term Retrospective Observation in Adults With Primary Immunodeficiencies

Abstract

Facilitated subcutaneous immunoglobulin (fSCIG) replacement therapy is the latest method of IgG administration; however, real-life data are limited. We retrospectively analyzed the everyday experience of fSCIG administration, particularly, the method used to switch from intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG) to fSCIG and the dosing modifications required. Of the 39 adult patients with primary immunodeficiency (PID) who received fSCIG, 34 remained on the therapy at the end of the study. The median observation time was 18 (range, 3-24) months. Two patients were IgG-treatment-naïve; 23 had previously received IVIG and 14 had received SCIG. In 25 cases, a non-ramp-up dosing mode was used to switch to fSCIG (including two half-monthly doses given biweekly in 14 cases, and full monthly doses given in 11 cases), a ramp-up mode was used in six cases; other methods were used in eight cases. The median IgG trough level at baseline was 7.9 g/L (n = 38), 7.9 g/L (n = 32) at Month 6, 9.0 g/L (n = 30) at Month 12, 8.6 g/L (n = 22) at Month 18, and 9.0 g/L (n = 11) at Month 24. No serious bacterial infections or hospitalizations due to PID complications occurred. At the end of the study, 24 patients (71%) received fSCIG every 4 weeks, six (18%) received fSCIG every 3 weeks, and four (12%) received fSCIG biweekly. In conclusion, our study provides real-life evidence of clinical efficacy of personalized fSCIG treatment when switching from prior immunoglobulin replacement using various switching modes and dosing frequencies.

Keywords: common variable immunodeficiency; fSCIG; hypogammaglobulinemia; personalized approach; pregnancy; primary immunodeficiency; real-life data; replacement immunoglobulin therapy.

Figure 1

Median trough immunoglobulin G (IgG) levels and median dose per 4 weeks of immunoglobulin therapy in: (A) patients that completed the 24-month follow-up, (B) patients that switched from subcutaneous immunoglobulin (SCIG) to fSCIG, (C) patients that switched from intravenous immunoglobulin (IVIG) to fSCIG, (D) patients that switched in a ramp-up mode, and (E) patients that switched in a non-ramp-up mode.

Figure 2

Median trough immunoglobulin G (IgG) levels and median immunoglobulin dose per 4 weeks among six patients that started of facilitated subcutaneous immunoglobulin (fSCIG) treatment after previous immunoglobulin (SCIG) and intravenous immunoglobulin (IVIG).