title: New Frontiers in Subcutaneous Immunoglobulin Treatment.
abstract: Subcutaneous immunoglobulin (SCIG) treatment provides stable serum immunoglobulin G (IgG) levels, is associated with fewer systemic adverse events than intravenous immunoglobulin (IVIG) treatment, and offers the convenience of home therapy. In clinical practice, IVIG is still used preferentially for initiation of treatment in newly diagnosed patients with primary immunodeficiency (PI) and for immunomodulatory therapy, such as treatment of peripheral neuropathies, when high doses are believed to be necessary. The authors discuss recent experience in using SCIG in place of IVIG in these settings. SCIG has been successfully used for initiation of therapy in previously untreated PI patients. Seventeen of 18 PI patients achieved serum IgG levels ≥5 g/L after the loading phase. Daily treatment was well tolerated and provided opportunities for patient/parent training in self-infusion. SCIG has been used for maintenance therapy in multifocal motor neuropathy (MMN) in three recent clinical trials, with good efficacy and tolerability results. Seven of eight MMN patients maintained serum IgG levels of 14-22 g/L with a mean dose of 272 mg/kg/week, had stable muscle strength, and felt comfortable with self-administration. Four patients with polymyositis or dermatomyositis achieved improvement in serum creatine kinase levels and muscle strength with SCIG therapy. Recent experience with SCIG suggests that traditional concepts of immunoglobulin therapy may be challenged to increase available therapy options. SCIG can be used to achieve high IgG levels within several days in untreated PI patients and to maintain high serum levels, as shown in patients with MMN.
authors.affiliation: University Hospital of Wales, Heath Park, Cardiff, CF14 4XW UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jolles
authors.affiliation: Allergy Associates of the Palm Beaches, North Palm Beach, FL USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Stein
authors.affiliation: Barts and London NHS Trust London, London, UK.
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Longhurst
authors.affiliation: Hospital "St. Georg" GmbH Leipzig, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Borte
authors.affiliation: Division of Hematology, Faculty of Medicine, University of Alberta, Edmonton, AB Canada.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ritchie
authors.affiliation: Department of Neurology, University Hospital and University of Berne, Berne, Switzerland.
authors.forename: Matthias H
authors.initials: MH
authors.lastname: Sturzenegger
authors.affiliation: CSL Behring LLC, King of Prussia, PA USA ; Case Western Reserve University, Cleveland, OH USA.
authors.forename: Melvin
authors.initials: M
authors.lastname: Berger
keywords: immunoglobulin G; immunoglobulin therapy; multifocal motor neuropathy; primary immunodeficiencies; serum levels; subcutaneous administration