Birincil immün yetmezliklerde deri altı immünglobulin kullanımı

Özet

Amaç: Birincil antikor yetmezliklerinde enfeksiyonların şiddet ve sıklığını azaltmak için immünglobulin yerine koyma tedavisi gerekmektedir. İmmünglobulin G (İgG) intramüsküler, intravenöz ve deri altı yoluyla verilebilir. Deri altı immünglobulin tedavisi alan 16 hastanın verileri geriye dönük sunularak, tedavi etkinliği, doz ayarlaması, yan etkilerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Hastaların dosya kayıtlarından demografik, klinik ve laboratuvar bulguları, deri altı immünglobulin uygulamasının dozu ve doz aralığı, uygulama süresi, bölgesi ve yöntemi, yan etkiler ve enfeksiyon sıklığı kaydedildi. Bulgular: Birincil immün yetmezlik tanılı 0-33 yaş arasında Deri altı İgG uygulanan 16 hasta (yedi kız, dokuz erkek) değerlendirmeye alındı. Hastalar deri altı immünglobulin öncesinde iki-dört haftada bir 0,331,25 g/kg doz aralığında %5-10 derişimde intravenöz immünglobulin almaktaydı. Deri altı immünglobulin ise 0,03-0,43 g/kg dozundan bir-iki hafta ara ile %10 derişimde ürün ile uygulandı. İntravenöz immünglobulin uygulamada doz öncesi serum vadi IgG düzeyleri ile subkütan immünglobulin tedavileri sırasında kararlı serum IgG düzeyleri arasında anlamlı bir fark saptanmadı. Ancak serum vadi İgG düzeyleri

Abstract

Aim: Immunoglobulin replacement therapy is required to reduce the frequency and severity of infections in patients with primary antibody deficiencies. Immunoglobulin G (IgG) can be administered intramuscularly, intravenously or subcutaneously. We aimed to evaluate the efficacy, dose adjustment and adverse events in subcutaneous immunoglobulin therapy by retrospectively presenting the records of 16 patients who received subcutaneous immunoglobulin therapy.Material and Methods: The demographic findings, clinical and laboratory findings, subcutaneous immunoglobulin dosage and dose frequency, infusion time, area and methods, adverse events and frequency of infections were obtained from patient files and recorded. Results: Sixteen patients (seven female, nine male) aged between 0-33 years who were diagnosed with primary immune deficiency and treated with subcutaneous immunoglobulin were enrolled. All patients had been receiving intravenous imunoglobulin (5-10%) at a dose of 0.331.25 gr/kg/dose with two-four week intervals before subcutaneous immunoglobulin. Subcutaneous immunoglobulin (10%) was administered at a dose of 0.03-0.43 gr/kg/dose with one-two week intervals. No significant difference was found between serum through IgG levels before administration of intravenous imunoglobulin and steady state IgG levels during subcutaneous immunoglobulin therapy. When five patients whose serum through IgG levels were below 600 mg/dL were evaluated, however, a significant increase was found in steady state IgG levels with subcutaneous immunoglobulin therapy (p=0.043). In a ten-month follow-up period, seven infections were observed in four patients (three upper respiratory infectons, two lower respiratory tract infections and three acute gastroenteritis). No acute severe bacterial infection was observed. Local advers reaction was reported in only 10 of 180 infusions (6%). No serious adverse events were reported. All 16 patients were willing to continue IgG replacement therapy by subcutaneous administration. Conclusions: Ig replacement therapy by subcutaneous route is an efficient, safe and easy option which is eligible for individual administration. Home therapy is feasible for patients with primary immune deficiency, if informed consent is obtained and sufficient education is ensured