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Review
. 2021 Sep;64(3):243-254.
doi: 10.1002/mus.27356. Epub 2021 Jul 14.

Subcutaneous immunoglobulin treatment for chronic inflammatory demyelinating polyneuropathy

Namita A Goyal  1 , Chafic Karam  2 , Kazim A Sheikh  3 , Mazen M Dimachkie  4
Affiliations
Review

Subcutaneous immunoglobulin treatment for chronic inflammatory demyelinating polyneuropathy

Namita A Goyal et al. Muscle Nerve. 2021 Sep.

Abstract

Immunoglobulin G (IgG) therapy is an established long-term treatment in chronic inflammatory demyelinating polyneuropathy (CIDP) that is commonly administered intravenously (IVIg). The subcutaneous immunoglobulin (SCIg) administration route is a safe and effective alternative option, approved by the United States Food and Drug Administration (FDA) in 2018, for maintenance treatment of adults with CIDP. Physicians and patients alike need to be aware of all their treatment options in order to make informed decisions and plan long-term treatment strategies. In this review, we collate the evidence for SCIg in CIDP from all published studies and discuss their implications and translation to clinical practice. We also provide guidance on the practicalities of how and when to transition patients from IVIg to SCIg and ongoing patient support. Evidence suggests that IVIg and SCIg have comparable long-term efficacy in CIDP. However, SCIg can provide additional benefits for some patients, including no requirement for venous access or premedication, and reduced frequency of systemic adverse events. Local-site reactions are more common with SCIg than IVIg, but these are mostly well-tolerated and abate with subsequent infusions. Data suggest that many patients prefer SCIg following transition from IVIg. SCIg preference may be a result of the independence and flexibility associated with self-infusion, whereas IVIg preference may be a result of familiarity and reliance on a healthcare professional for infusions. In practice, individualizing maintenance dosing based on disease behavior and determining the minimally effective IgG dose for individuals are key considerations irrespective of the administration route chosen.

Keywords: CIDP; IVIg; SCIg; immunoglobulin therapy; transition.

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Conflict of interest statement

Mazen Dimachkie serves, or recently served, as a consultant for ArgenX, Catalyst, Cello, CSL Behring, EcoR1, Kezar, Momenta, NuFactor, Octapharma, RaPharma/UCB, RMS Medical, Sanofi Genzyme, Shire Takeda, Spark Therapeutics and UCB Biopharma. Dr. Dimachkie received grants from Alexion, Alnylam Pharmaceuticals, Amicus, Biomarin, Bristol‐Myers Squibb, Catalyst, Corbus, CSL‐Behring, FDA/OOPD, GlaxoSmithKline, Genentech, Grifols, Kezar, Mitsubishi Tanabe Pharma, MDA, NIH, Novartis, Octapharma, Orphazyme Ra Pharma/UCB, Sanofi Genzyme, Sarepta Therapeutics, Shire Takeda, Spark Therapeutics, UCB Biopharma, Viromed/Healixmith & TMA. Namita Goyal has received research support from Brainstorm Cell Therapeutics, Cytokinetics, Fulcrum, Kezar, Octapharma, Orion, Orphazyme. Dr. Goyal has served on Advisory Boards for Acceleron, Alexion, Argenx, Biogen, CSL Behring, Cytokinetics, MT Pharma, Sanofi Genzyme, Sarepta. In relation to these activities, she has received travel reimbursement and honoraria. She has also served on the speaker's bureau for CSL. The remaining authors have no conflicts of interest. Kazim Sheikh has received personal compensation for speaking engagements from CSL Behring and research/grant support from the Department of Defense (W81XWH‐18‐1‐0422) and the National Institute of Neurological Disorders and Stroke (R21NS107961). Chafic Karam has consulted for Acceleron Pharma, Inc; Akcea Therapeutics; Alnylam Pharmaceuticals, Inc; Argenx; Biogen; CSL Behring; and Sanofi Genzyme. Dr Karam has received personal compensation for speaking engagements from Akcea Therapeutics; Alnylam Pharmaceuticals, Inc; CSL Behring; and Sanofi Genzyme and research/grant support from Akcea Therapeutics and Sanofi Genzyme.

Figures

FIGURE 1
FIGURE 1
Schematic of intravenous vs subcutaneous infusions and the impact on IgG concentration. Dependent on infusion site location and patient preference, subcutaneous infusions can be conducted at a 90‐ or 45° angle. Red line indicates where IVIg dose is followed 1 wk later by SCIg maintenance doses
FIGURE 2
FIGURE 2
Subject preference for SCIg and IVIg. Not all subjects in the clinical trial responded to the preference questionnaire. Numbers above bars are actual numbers of subjects who responded
See this image and copyright information in PMC

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