title: Subcutaneous Immunoglobulin Therapy in the Chronic Management of Myasthenia Gravis: A Retrospective Cohort Study.
abstract: BACKGROUND
  Immunoglobulin therapy has become a major treatment option in several autoimmune neuromuscular disorders. For patients with Myasthenia Gravis (MG), intravenous immunoglobulin (IVIg) has been used for both crisis and chronic management. Subcutaneous Immunoglobulins (SCIg), which offer the advantage of home administration, may be a practical and effective option in chronic management of MG. We analyzed clinical outcomes and patient satisfaction in nine cases of chronic disabling MG who were either transitioned to, or started de novo on SCIg.
  
  
  RESULTS
  This was a retrospective cohort study for the period of 2015-2016, with a mean follow-up period of 6.8 months after initiation of SCIg. All patients with MG treated with SCIg at the Ottawa Hospital, a large Canadian tertiary hospital with subspecialty expertise in neuromuscular disorders were included, regardless of MG severity, clinical subtype and antibody status. The primary outcome was MG disease activity after SCIg initiation. This outcome was measured by 1) the Myasthenia Gravis Foundation of America (MGFA) clinical classification, and 2) subjective scales of disease activity including the Myasthenia Gravis activities of daily living profile (MG-ADL), Myasthenia Gravis Quality-of-life (MG-QOL 15), Visual Analog (VA) satisfaction scale. We also assessed any requirement for emergency department visits or hospitalizations. Safety outcomes included any SCIg related complication. All patients were stable or improved for MGFA class after SCIg initiation. Statistically significant improvements were documented in the MG-ADL, MG-QOL and VAS scales. There were no exacerbations after switching therapy and no severe SCIg related complications.
  
  
  CONCLUSIONS
  SCIg may be a beneficial therapy in the chronic management of MG, with favorable clinical outcome and patient satisfaction results.
authors.affiliation: The Ottawa Hospital, Department of Medicine, Division of Neurology, Ottawa, Canada.|University of Ottawa, Faculty of Medicine, Ottawa, Canada.
authors.forename: P R
authors.initials: PR
authors.lastname: Bourque
authors.affiliation: The Ottawa Hospital, Department of Medicine, Division of Neurology, Ottawa, Canada.|University of Ottawa, Faculty of Medicine, Ottawa, Canada.
authors.forename: C E
authors.initials: CE
authors.lastname: Pringle
authors.affiliation: University of Ottawa, Faculty of Medicine, Ottawa, Canada.|The Ottawa Hospital, Department of Medicine, Division of Infectious Diseases, Ottawa, Canada.|The Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Cameron
authors.affiliation: University of Ottawa, Faculty of Medicine, Ottawa, Canada.|The Ottawa Hospital, Department of Medicine, Division of Infectious Diseases, Ottawa, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Cowan
authors.affiliation: The Ottawa Hospital, Department of Medicine, Division of Neurology, Ottawa, Canada.|University of Ottawa, Faculty of Medicine, Ottawa, Canada.|The Ottawa Hospital Research Institute, Ottawa, Canada.|Children's Hospital of Eastern Ontario, Division of Genetics, Ottawa, Canada.
authors.forename: J Warman
authors.initials: JW
authors.lastname: Chardon
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy*; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors