title: Subcutaneous immunoglobulin: opportunities and outlook.
abstract: Immunoglobulin (Ig) administration via the subcutaneous (s.c.) route has become increasingly popular in recent years. The method does not require venous access, is associated with few systemic side effects and has been reported to improve patients' quality of life. One current limitation to its use is the large volumes which need to be administered. Due to the inability of tissue to accept such large volumes, frequent administration at multiple sites is necessary. Most studies conducted to date have investigated the use of subcutaneous immunoglobulin (SCIg) in patients treated previously with the intravenous (i.v.) formulation. New data now support the use of s.c. administration in previously untreated patients with primary immunodeficiencies. SCIg treatment may further be beneficial in the treatment of autoimmune neurological conditions, such as multi-focal motor neuropathy; however, controlled trials directly comparing the s.c. and i.v. routes are still to be performed for this indication. New developments may further improve and facilitate the s.c. administration route. For example, hyaluronidase-facilitated administration increases the bioavailability of SCIg, and may allow for the administration of larger volumes at a single site. Alternatively, more concentrated formulations may reduce the volume required for administration, and a rapid-push technique may allow for shorter administration times. As these developments translate into clinical practice, more physicians and patients may choose the s.c. administration route in the future.
authors.affiliation: John Radcliffe Hospital, Oxford, UK. siraj.misbah@orh.nhs.uk
authors.forename: S
authors.initials: S
authors.lastname: Misbah
authors.forename: M H
authors.initials: MH
authors.lastname: Sturzenegger
authors.forename: M
authors.initials: M
authors.lastname: Borte
authors.forename: R S
authors.initials: RS
authors.lastname: Shapiro
authors.forename: R L
authors.initials: RL
authors.lastname: Wasserman
authors.forename: M
authors.initials: M
authors.lastname: Berger
authors.forename: H D
authors.initials: HD
authors.lastname: Ochs
mesh_terms: D000951:Antigens, Neoplasm / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004337:Drug Carriers; D051548:Histone Acetyltransferases / Q000008:administration & dosage; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000627:therapeutic use; D055104:Infusions, Subcutaneous; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000951:Antigens, Neoplasm; D004337:Drug Carriers; D007074:Immunoglobulin G; D011994:Recombinant Proteins; D051548:Histone Acetyltransferases; C115866:OGA protein, human; D006821:Hyaluronoglucosaminidase