IVIG/SCIG Treatment in Patients with Primary Immunodeficiency Diseases

immunoloji-17-1-2024

Filiz SADİ AYKANa
aNecmettin Erbakan University Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergy Diseases, Konya, Türkiye

Sadi Aykan F. IVIG/SCIG treatment in patients with primary immunodeficiency diseases. Çölkesen F, ed. Primary Immunodeficiency Diseases in Adults. 1st ed. Ankara: Türkiye Klinikleri; 2024. p.105-14.

ABSTRACT
Human immunoglobulin preparations form the basis of human therapy in patients with primary immunodeficiency (PID) in whom the humoral immune system is affected. This immunoglobulin is produced from large plasma pools from 15.000-60.000 individuals. Immunoglobulin replacement therapy (IgRT) helps prevent bacterial severe infections and long-term infection-related complications, especially lung disease, in PID patients. The starting dose is 400-600 mg/kg every four weeks. Stabilization takes up to 3 months. Dosage adjustment should be based on clinical condition and steady-state levels for IgG trough for intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG). Higher IgG trough levels (>800-1000 mg/dL) may be required in selected patients, especially those with chronic lung disease. Differences in product composition and manufacturing may lead to individual side effects and tolerability variations. Therefore, IVIG products should not be used interchangeably. Mild adverse reactions related to the infusion rate are frequently seen with IVIG. Serious systemic adverse events such as renal failure, thromboembolic events and hemolysis are rare and even less frequent with SCIG. SCIG has fewer systemic adverse reactions, while local site reactions are more frequent. After initiating IgRT, follow-up evaluation is recommended every 3-4 months for the first year and every 6-12 months after that. At follow-up, the tolerability and efficacy of treatment should be reviewed and trough or steady-state serum IgG levels should be measured.

Keywords: Primary immunodeficiency; intravenous immunoglobulin; subcutaneous immunoglobulin; advers reaction

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