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Review
. 2024;16(13):895-905.
doi: 10.1080/1750743X.2024.2382074. Epub 2024 Sep 26.

Immunoglobulin therapies for primary immunodeficiency diseases (part 2): considerations for dosing strategies

Zhaoyang Li  1 , Iftekhar Mahmood  1
Affiliations
Review

Immunoglobulin therapies for primary immunodeficiency diseases (part 2): considerations for dosing strategies

Zhaoyang Li et al. Immunotherapy. 2024.

Abstract

Immunoglobulin G (IgG) dosing in treating primary immunodeficiency diseases (PIDs) is individualized, which often involves regular monitoring of IgG levels, and considers patient experiences with immunoglobulin therapies, their clinical status and physician judgment. The frequency and dose(s) of intravenously (IVIG) and subcutaneously (SCIG) administered IgGs (including hyaluronidase-facilitated SCIG) require rigorous evaluation to maximize therapeutic benefits. Monitoring serum IgG levels represents an integral part of diagnosing primary immunodeficiency diseases and determining or adjusting IgG dosing strategies to meet individual patient needs, but cannot be conducted in isolation. This review discusses the current state and future perspectives on dosing strategies for different types of IgG therapies, as well as dosing considerations for specific patient populations, immunoglobulin-naive patients and patients switching between IVIG and SCIG.

Keywords: IVIG; SCIG; dose; immunoglobulin; primary immunodeficiencies; trough levels.

Plain language summary

Primary immunodeficiency diseases (PIDs) are a group of genetic conditions where the immune system does not work properly. Antibodies produced by the immune system help the body fight infections. PIDs can be treated with a type of antibody called immunoglobulin G (IgG), which can be given into the vein or under the skin. Determining what dose of IgG should be given to a person involves blood tests, doctors’ judgment and preferences of people for how they receive treatment. Here we discuss the current strategies for choosing the right dose of IgG as well as future perspectives. We also reflect on how these methods may vary for different groups of people with PIDs, and for people starting or switching between treatments.

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Conflict of interest statement

Z Li is an employee of Takeda Development Center Americas, Inc., and is a Takeda shareholder. I Mahmood is a consultant to Takeda Development Center Americas, Inc. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
Immunoglobulin G trough levels following treatment with conventional subcutaneous immunoglobulin versus intravenous immunoglobulin. This figure has been adapted with permission from [23], Elsevier Inc. CI: Confidence interval; IV: Intravenous; IVIG: Intravenous immunoglobulin; SCIG: Subcutaneous immunoglobulin; SD: Standard deviation.
See this image and copyright information in PMC

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