TY - JOUR
T1 - Impact of IVIG vs. SCIG on IgG trough level and infection incidence in primary immunodeficiency diseases
T2 - A systematic review and meta-analysis of clinical studies
AU - Shrestha, Pragya
AU - Karmacharya, Paras
AU - Wang, Zhen
AU - Donato, Anthony
AU - Joshi, Avni Y.
N1 - Funding Information:
The project was supported by grant T32 GM08685 (Pragya Shrestha) from National Institutes of Health and CTSA Grant Number UL1 TR002377 from the National Center for Advancing Translational Science (NCATS) (Paras Karmacharya).
Funding Information:
The project was supported by grant T32 GM08685 (Pragya Shrestha) from National Institutes of Health and CTSA Grant Number UL1 TR002377 from the National Center for Advancing Translational Science (NCATS) (Paras Karmacharya).
Publisher Copyright:
© 2019 The Authors
PY - 2019/10
Y1 - 2019/10
N2 - Background: Monthly intravenous immunoglobulin (IVIG) and weekly subcutaneous immunoglobulin (SCIG) have been regarded as therapeutically equivalent treatments for primary immunodeficiency diseases (PIDD). Immunoglobulin G (IgG) trough level is used as a monitoring measure for infection prevention. Objective: A systematic review and meta-analysis were performed to elucidate the relationship between IgG dosing, trough IgG levels with overall infection incidence in patients with PIDD receiving IVIG and SCIG therapy. Methods: Medline, EMBASE, Cochrane, Central, and Scopus were searched for studies published from Jan 2010–June 2018, fulfilling the inclusion criteria. DerSimonian and Laird random-effects method were used to pool the difference of IgG trough levels. Random-effect meta-regression was used to evaluate infection incidence per 100 mg/dl IgG trough increase though IVIG and SCIG. Results: Out of 24 observational studies included, 11 compared IgG trough levels among SCIG and IVIG (mean difference: 73.4 mg/dl, 95% CI: 31.67–119.19 mg/dl, I2 = 45%, p = 0.05), favoring weekly SCIG. For every 100 mg/dl increase in the trough, a linear trend of decreased incidence rates of infection was identified in SCIG patients (p = 0.03), but no similar trend was identified in trough levels vs. infection rates for patients receiving IVIG (p = 0.67). Conclusion: In our study, weekly SCIG attained a higher trough level in comparison to monthly IVIG. Higher SCIG troughs were associated with lower infection rates, while IVIG troughs demonstrated no relationship.
AB - Background: Monthly intravenous immunoglobulin (IVIG) and weekly subcutaneous immunoglobulin (SCIG) have been regarded as therapeutically equivalent treatments for primary immunodeficiency diseases (PIDD). Immunoglobulin G (IgG) trough level is used as a monitoring measure for infection prevention. Objective: A systematic review and meta-analysis were performed to elucidate the relationship between IgG dosing, trough IgG levels with overall infection incidence in patients with PIDD receiving IVIG and SCIG therapy. Methods: Medline, EMBASE, Cochrane, Central, and Scopus were searched for studies published from Jan 2010–June 2018, fulfilling the inclusion criteria. DerSimonian and Laird random-effects method were used to pool the difference of IgG trough levels. Random-effect meta-regression was used to evaluate infection incidence per 100 mg/dl IgG trough increase though IVIG and SCIG. Results: Out of 24 observational studies included, 11 compared IgG trough levels among SCIG and IVIG (mean difference: 73.4 mg/dl, 95% CI: 31.67–119.19 mg/dl, I2 = 45%, p = 0.05), favoring weekly SCIG. For every 100 mg/dl increase in the trough, a linear trend of decreased incidence rates of infection was identified in SCIG patients (p = 0.03), but no similar trend was identified in trough levels vs. infection rates for patients receiving IVIG (p = 0.67). Conclusion: In our study, weekly SCIG attained a higher trough level in comparison to monthly IVIG. Higher SCIG troughs were associated with lower infection rates, while IVIG troughs demonstrated no relationship.
KW - IVIG
KW - IgG trough
KW - PIDD
KW - Primary immunodeficiency disease
KW - SCIG
UR - http://www.scopus.com/inward/record.url?scp=85072949498&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072949498&partnerID=8YFLogxK
U2 - 10.1016/j.waojou.2019.100068
DO - 10.1016/j.waojou.2019.100068
M3 - Article
AN - SCOPUS:85072949498
SN - 1939-4551
VL - 12
JO - World Allergy Organization Journal
JF - World Allergy Organization Journal
IS - 10
M1 - 100068
ER -