Advantage of the subcutaneous immunoglobulin replacement therapy in primary immunodeficient patients with or without secondary protein loss

Özet

In recent years subcutaneous immunoglobulin is widely used for primaryimmunodeficient patients. Subcutaneous administration provides a morestable and higher serum immunoglobulin levels due to continuous andsteady transition from lymphatics to the systemic circulation. We aimed toevaluate the changes in serum immunoglobulin levels under subcutaneousimmunoglobulin therapy in patients with primary immunodeficiency with orwithout secondary protein loss. Nine patients with primary immunodeficiencywho switched to subcutaneous immunoglobulin were enrolled. Age, gender,diagnosis, reasons of transition to subcutaneous route, reasons of secondaryprotein loss were recorded. A questionnaire consisting of frequencies andtypes of infections, side effects observed with intravenous and subcutaneousroutes; date and reason of transition to subcutaneous route were asked toall participants. Serum immunoglobulin levels at the 3rd and the 6th monthsbefore and after subcutaneous route were recorded. Of the 9 patients (M/F=4/5) the median age was 12 years (6.1-28.7) and 5 of them had proteinloss. In total, 444 injections were applied, and all patients experienced localreactions. Infections were more frequent under intravenous than subcutaneousroute (p=0.004). We observed an increase in immunoglobulin levels undersubcutaneous route (p=0.069 at 3rd; p=0.13 at 6th month). This increasewas evident at the 3rd month of transition to subcutaneous route in patientswith protein loss (p=0.080). There was an increase in serum immunoglobulinlevels under subcutaneous route. However, increase was not statisticallysignificant since the study group was small. This increment was prominentin patients with protein loss. Subcutaneous administration may be a goodalternative for primary immunodeficient patients with protein loss whohave persistent low serum immunoglobulin levels despite increments in theintravenous immunoglobulin doses.