Skip to main content Accessibility help
×
Home

Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for Neurological Patients

  • Adam Suleman (a1), Lynda Theoret (a2), Pierre Bourque (a3), Elizabeth Pringle (a3), D. William Cameron (a2) (a4) and Juthaporn Cowan (a2) (a4)...

Abstract

Background

Subcutaneous immunoglobulin (SCIg) treatment has been shown to control symptoms and improve overall satisfaction in patients with neurological disorders. However, a large injection volume can be overwhelming and a barrier to successful SCIg treatment. We established a nurse-led individualized approach program to facilitate a smooth and successful treatment transition from intravenous immunoglobulin (IVIg) to SCIg. The program involved a lead nurse to provide two or more individual educational sessions on SCIg administration, establish a written transition plan, and liaise care with physicians.

Objectives

We aimed to evaluate the impact of our program to a successful transition defined as SCIg retention or adherence without a need to restart IVIg by six or twelve months.

Methods

We reviewed medical charts of all patients with immune-mediated neuromuscular disorders who were in our program during January 2010 to Dec 2016.

Results

Nineteen patients were identified. Mean IVIg treatment duration was 31.5 months (range 4-98) before the transition. Mean steady state SCIg dosage was 26.2 g/week (SD 10.3). All patients were initially able to switch to SCIg, with a retention rate of 17/19 (89.5%) at six months and 15/19 (78.9%) at twelve months. Two patients reverted back to IVIg treatment due to worsening of their symptoms at two and three months, while two required supplemental IVIg infusions. There were no major adverse events reported during the twelve-month period, but one minor cutaneous adverse event (redness around the injection site).

Conclusions

Successful treatment transition may be achieved with the nurse led individualized approach program.

Évaluation d’un programme de traitement personnalisé à l’immunoglobuline par voie sous-cutanée destiné à des patients atteints de troubles neurologiques.

Contexte

Il a été prouvé que les traitements à l’immunoglobuline par voie sous-cutanée (IgSC) permettent de contrôler les symptômes qui affectent des patients atteints de troubles neurologiques et d’améliorer leur satisfaction générale. Toutefois, de grands volumes injectés peuvent devenir accablants et représenter un obstacle à un traitement par IgSC qui soit efficace. Nous avons ainsi mis sur pied un programme reposant sur une approche individuelle et dirigé par du personnel infirmier afin de favoriser une transition en douceur efficace entre les traitements d’immunoglobuline par voie intraveineuse (IgIV) et ceux par IgSC. Un tel programme impliquait la présence d’une infirmière en chef chargée d’offrir deux séances de formation ou plus en ce qui concerne l’administration d’un traitement par IgSC mais aussi d’établir un plan écrit de transition entre les deux traitements et d’assurer une liaison avec les médecins traitants.

Objectifs

Nous avons cherché à évaluer l’impact de notre programme en matière de transition. C’est ainsi que nous avons voulu savoir dans quelle mesure un traitement par IgSC entraînait une forme d’adhésion thérapeutique en vertu de laquelle un traitement par IgIV n’était plus nécessaire au bout de six ou de 12 mois.

Méthodes

Nous avons passé en revue les dossiers médicaux de tous les patients atteints de troubles neuromusculaires d’origine auto-immune ayant fait partie de notre programme de janvier 2010 à décembre 2016.

Résultats

Au total, dix-neuf patients ont été sélectionnés. Avant d’amorcer notre transition, la durée moyenne d’un traitement par IgIV était de 31,5 mois (étendue : 4-98). La posologie moyenne à l’équilibre d’un traitement par IgSC était de 26,2 g/semaine (écart-type : 10,3). Au début, tous les patients ont été en mesure de passer à un traitement par IgSC, le taux d’adhésion étant de 89,5 % (17/19) au bout de six mois et de 78,9 % (15/19) au bout de douze mois. Deux patients ont recommencé à suivre un traitement par IgIV en raison d’une détérioration de leurs symptômes au bout de deux et de trois mois tandis que deux autres ont eu besoin d’injections à l’immunoglobuline additionnelles. Outre un seul événement indésirable mineur de nature cutanée, à savoir de la rougeur autour de la zone d’injection, aucun événement indésirable majeur n’a été signalé au cours de la période de transition de douze mois.

Conclusions

Il est possible, au moyen d’un programme dirigé par une infirmière chef dont l’approche est individuelle, d’effectuer une transition efficace entre les deux traitements évoqués ci-dessus.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for Neurological Patients
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for Neurological Patients
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Evaluation of a Personalized Subcutaneous Immunoglobulin Treatment Program for Neurological Patients
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence to: J. Cowan, PhD, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 223, Ottawa, Ontario, K1H 8L6. Email: jcowan@toh.ca

References

Hide All
1. Lünemann, JD, Quast, I, Dalakas, MC. Efficacy of intravenous immunoglobulin in neurological diseases. Neurother J Am Soc Exp Neurother. 2016;13(1):34-46.
2. Windegger, TM, Lambooy, CA, Hollis, L, Morwood, K, Weston, H, Fung, YL. Subcutaneous immunoglobulin therapy for hypogammaglobulinemia secondary to malignancy or related drug therapy. Transfus Med Rev. 2017;31(1):45-50.
3. Leussink, VI, Hartung, H-P, Kieseier, BC, Stettner, M. Subcutaneous immunoglobulins in the treatment of chronic immune-mediated neuropathies. Ther Adv Neurol Disord. 2016;9(4):336-343.
4. Shabaninejad, H, Asgharzadeh, A, Rezaei, N, Rezapoor, A. A comparative study of intravenous immunoglobulin and subcutaneous immunoglobulin in adult patients with primary immunodeficiency diseases: a systematic review and meta-analysis. Expert Rev Clin Immunol. 2016;12(5):595-602.
5. Bourque, PR, Pringle, CE, Cameron, W, Cowan, J, Chardon, JW. Subcutaneous immunoglobulin therapy in the chronic management of myasthenia gravis: a retrospective cohort study. PLoS ONE. 2016;11(8):e0159993. https://doi.org/10.1371/journal.pone.0159993.
6. Markvardsen, LH, Harbo, T. Subcutaneous immunoglobulin treatment in CIDP and MMN. Efficacy, treatment satisfaction and costs. J Neurol Sci. 2017;378:19-25.
7. Harbo, T, Andersen, H, Jakobsen, J. Long-term therapy with high doses of subcutaneous immunoglobulin in multifocal motor neuropathy. Neurology. 2010;75(15):1377-1380.
8. van Schaik, IN, Bril, V, van Geloven, N, et al. Subcutaneous immunoglobulin for maintenance treatment in chronic inflammatory demyelinating polyneuropathy (PATH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2018;17(1):35-46.
9. Misbah, SA, Baumann, A, Fazio, R, et al. A smooth transition protocol for patients with multifocal motor neuropathy going from intravenous to subcutaneous immunoglobulin therapy: an open-label proof-of-concept study. J Peripher Nerv Syst JPNS. 2011;16(2):92-97.
10. Hadden, RDM, Marreno, F. Switch from intravenous to subcutaneous immunoglobulin in CIDP and MMN: improved tolerability and patient satisfaction. Ther Adv Neurol Disord. 2015;8(1):14-19.
11. Fadeyi, M, Tran, T. Calculating the dose of subcutaneous immunoglobulin for primary immunodeficiency disease in patients switched from intravenous to subcutaneous immunoglobulin without the use of a dose-adjustment coefficient. Pharm Ther. 2013;38(12):768-770.
12. Rasutis, VM, Katzberg, HD, Bril, V. High-dose subcutaneous immunoglobulin in patients with multifocal motor neuropathy: a nursing perspective. J Infus Nurs Off Publ Infus Nurses Soc. 2017;40(5):305-312.
13. Wasserman, RL, Melamed, I, Nelson, RP, et al. Pharmacokinetics of subcutaneous IgPro20 in patients with primary immunodeficiency. Clin Pharmacokinet. 2011;50(6):405-414.
14. IBM SPSS Statistics 20 Available for Download - United States [Internet]. 2016 [cited 2018 May 9]. Available from: http://www.ibm.com/support, https://www-304.ibm.com/support/docview.wss?uid=swg21509012
15. Katzberg, HD, Rasutis, V, Bril, V. Subcutaneous immunoglobulin for treatment of multifocal motor neuropathy. Muscle Nerve. 2016;54(5):856-863.
16. Cocito, D, Merola, A, Peci, E, et al. Subcutaneous immunoglobulin in CIDP and MMN: a short-term nationwide study. J Neurol. 2014;261(11):2159-2164.
17. Orbach, H, Katz, U, Sherer, Y, Shoenfeld, Y. Intravenous immunoglobulin: adverse effects and safe administration. Clin Rev Allergy Immunol. 2005;29(3):173-184.
18. Markvardsen, LH, Christiansen, I, Andersen, H, Jakobsen, J. Headache and nausea after treatment with high-dose subcutaneous versus intravenous immunoglobulin. Basic Clin Pharmacol Toxicol. 2015;117(6):409-412.
19. Racosta, JM, Sposato, LA, Kimpinski, K. Subcutaneous versus intravenous immunoglobulin for chronic autoimmune neuropathies: A meta-analysis. Muscle Nerve. 2017;55(6):802-809.
20. Gerth, WC, Betschel, SD, Zbrozek, AS. Implications to payers of switch from hospital-based intravenous immunoglobulin to home-based subcutaneous immunoglobulin therapy in patients with primary and secondary immunodeficiencies in Canada. Allergy Asthma Clin Immunol Off J Can Soc Allergy Clin Immunol. 2014;10(1):23.
21. Perraudin, C, Bourdin, A, Spertini, F, Berger, J, Bugnon, O. Switching patients to home-based subcutaneous immunoglobulin: an economic evaluation of an interprofessional drug therapy management program. J Clin Immunol. 2016;36(5):502-510.
22. Subcutaneous Immunoglobulin Home Infusion Program | Providence Health Care [Internet]. [cited 2018 Aug 11]. Available from: http://www.providencehealthcare.org/subcutaneous-immunoglobulin-home-infusion-program

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed