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 - 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 -