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Review
. 2022 Dec 1;22(6):371-379.
doi: 10.1097/ACI.0000000000000864. Epub 2022 Sep 27.

Immunodeficient patient experience of emergency switch from intravenous to rapid push subcutaneous immunoglobulin replacement therapy during coronavirus disease 2019 shielding

Clare Morgan  1 , Stephen Jolles  2 , Mark J Ponsford  2   3 , Kimberly Evans  2 , Emily Carne  2
Affiliations
Review

Immunodeficient patient experience of emergency switch from intravenous to rapid push subcutaneous immunoglobulin replacement therapy during coronavirus disease 2019 shielding

Clare Morgan et al. Curr Opin Allergy Clin Immunol. .

Abstract

Purpose of review: Welsh immunodeficient patients on immunoglobulin replacement therapy (IgRT) who were considered high risk for severe coronavirus disease 2019 (COVID-19) were directed to shield. Consequently, patients receiving hospital-based intravenous immunoglobulin (IVIg) quickly transitioned to home-based self-administered subcutaneous immunoglobulin (SCIg). This evaluation aimed to assess patients' perceptions and experiences and laboratory outcomes of emergency IgRT transition during COVID-19.

Recent findings: A quick transition from in-hospital IVIg to home-based rapid push SCIg is achievable, however, patient IgRT administration preference remains key outside of emergency shielding measures.

Summary: Subjective self-reported experiences ( n = 23) and objective immunoglobulin G (IgG) concentration ( n = 28) assessments were prospectively collected from patients pre/post-IgRT switch. In total, 41/55 (75%) patients transitioned from IVIg to rapid push SCIg and all completed training to self-administer subcutaneously within 24 days. Twenty-two percent ( n = 5) of patients preferred SCIg and 35% ( n = 8) wanted to return to hospital-based IVIg at 6 weeks post-transition. Mean IgG levels were similar pre vs. post-SCIg switch (10.3 g/l vs. 10.6 g/l, respectively). Patients reported greater infection anxiety during COVID-19 and adapted behaviours to mitigate risk. Although a third of patients wished to return to IVIg following cessation of shielding, over time the percentage electing to remain on SCIg rose from 22% to 59%.

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Conflict of interest statement

S.J. has received support for conferences, speaker, advisory boards, trials, data and safety monitoring boards, and projects with CSL Behring, Takeda, Swedish Orphan Biovitrum, Biotest, Binding Site, Grifols, BPL, Octapharma, LFB, Pharming, GSK, Weatherden, Zarodex, Sanofi, and UCB Pharma.

Figures

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Box 1
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FIGURE 1
FIGURE 1
TSQM II medication satisfaction scores for patients switching from IVIg to SCIg (n = 21). IVIg, intravenous immunoglobulin; SCIg, subcutaneous immunoglobulin; TSQM II, Treatment Satisfaction Questionnaire for Medication Version II.
FIGURE 2
FIGURE 2
Patient experience of IVIg to SCIg switch. IVIg, intravenous immunoglobulin; SCIg, subcutaneous immunoglobulin.
See this image and copyright information in PMC

References

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    1. Public Health England. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19. 2020. Available at: https://www.gov.uk/government/publications/guidance-on-shielding-and-pro....
    1. Welsh Government. Guidance on protecting people defined on medical grounds as clinically extremely vulnerable from coronavirus (COVID-19) – previously known as ‘shielding’. 2020. Available at: https://gov.wales/guidance-on-shielding-and-protecting-people-defined-on....
    1. Freedman L. Strategy for a pandemic: the UK and COVID-19. Survival 2020; 62:25–76.

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