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. 2021 Apr;268(4):1485-1490.
doi: 10.1007/s00415-020-10318-3. Epub 2021 Feb 20.

Subcutaneous immunoglobulin dose titration to clinical response in inflammatory neuropathy

Mahima Kapoor  1 , Ryan Keh  2 , Laura Compton  1 , Sarah Morrow  2 , David Gosal  2 , Hadi Manji  1 , Mary M Reilly  1 , Michael P Lunn  1 , Tim M Lavin  2 , Aisling S Carr  3
Affiliations

Subcutaneous immunoglobulin dose titration to clinical response in inflammatory neuropathy

Mahima Kapoor et al. J Neurol. 2021 Apr.

Abstract

Introduction: Individualized dosing is an established approach in intravenous immunoglobulin (IVIg) treatment for inflammatory neuropathies. There is less experience in effective dosing strategies for subcutaneous (SC) immunoglobulin.

Methods: We conducted a retrospective cohort study of patients with inflammatory neuropathies transferring from IVIg to SCIg in two UK peripheral nerve services. I-RODS and grip strength were used to measure outcome. Dose and clinical progress were documented at 1 year and at last review.

Results: 44/56 patients remained on maintenance SCIg beyond 1 year (mean 3.3 years, range 1-9 years) with stable clinical outcomes. Clinical deteriorations were corrected by small increases in SCIg dose in 20 patients at 1 year, a further 9 requiring subsequent further up-titrations. Sixteen tolerated dose reduction. Mean dose change was + 2.4% from baseline. Two patients required IVIg bolus rescue (2 g/kg). Three patients successfully discontinued Ig therapy. Nine patients returned to IVIg due to clinical relapse or patient preference. Overall tolerance was good.

Discussion: Dose titration to clinical response is an effective approach in SCIg maintenance therapy.

Keywords: Chronic inflammatory demyelinating polyradiculoneuropathy; Immunoglobulin; Immunology; Peripheral neuropathy; Subcutaneous.

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