title: Intravenous and subcutaneous immunoglobulin replacement: a two-way road. Optimizing healthcare quality in patients with primary immunodeficiencies.
abstract: OBJECTIVE
  To evaluate the alternate use of subcutaneous immunoglobulin (SCIG) and intravenous immunoglobulin (IVIG) in patients with primary immunodeficiencies (PID) in a third-level Pediatric University Hospital.
  
  
  METHODS
  Retrospective study of all patients receiving SCIG from 2006 to 2012. Data collected included demographics, date SCIG was started, date of switch to IVIG and reasons, administration tolerance, and related adverse events. Effectiveness was defined as the lack of severe infections.
  
  
  RESULTS
  Twenty-three patients (15 male, 8 female) with PID were studied. SCIG was initiated at a median age of 14.2 years (8.4 months-25.7 years) and median duration on SCIG treatment was 41 months (4-68). Nine patients (39.1%) temporarily switched from SCIG to IVIG for the following reasons: vacation (8), administration issues (1), and transient need for immunomodulatory therapy (1). A mean of 5.2 IVIG infusions/patient (SD=2.86) was administered while on SCIG. IVIG-related adverse events were documented in 3 patients with 6 infusions. Eight (34.8%) patients definitively discontinued SCIG use for the following reasons: convenience (5), adverse effects (1), coagulopathy (1), and autoimmune thrombocytopenia (1). There were no severe infections requiring hospital admission in any patient during the study period.
  
  
  CONCLUSIONS
  Alternating SCIG and IVIG use in patients with PID was associated with considerable advantages in terms of convenience for the patients and their caregivers, while maintaining the effectiveness and safety of this therapy. Healthcare units treating these patients should show flexibility with this dual therapy in order to optimize patients' quality of life.
authors.affiliation: Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron. Institut de Recerca Vall d'Hebron. Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain, psoler@vhebron.net.
authors.forename: Pere
authors.initials: P
authors.lastname: Soler-Palacín
authors.forename: Ingrid
authors.initials: I
authors.lastname: Gasó-Gago
authors.forename: Aurora
authors.initials: A
authors.lastname: Fernández-Polo
authors.forename: Andrea
authors.initials: A
authors.lastname: Martín-Nalda
authors.forename: María
authors.initials: M
authors.lastname: Oliveras
authors.forename: Julio
authors.initials: J
authors.lastname: Martinez-Cutillas
authors.forename: Concepció
authors.initials: C
authors.lastname: Figueras
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007153:Immunologic Deficiency Syndromes / Q000628:therapy*; D007223:Infant; D055104:Infusions, Subcutaneous; D008297:Male; D012189:Retrospective Studies
chemical_list: D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous