Original Article

Improved Quality of Life, Immunoglobulin G Levels, and Infection Rates in Patients with Primary Immunodeficiency Diseases during Self-Treatment with Subcutaneous Immunoglobulin G

Authors: Melvin Berger, MD, PhD, Elyse Murphy, RN, BSN, Patty Riley, RN, BAN, CRN, Garrett E. Bergman, MD The VIRTUE Trial Investigators

Abstract

Objectives: Primary immunodeficiency diseases (PIDDs) include a large class of genetically heterogeneous disorders which predispose patients to significant risk of serious and chronic/recurrent infections, as well as reduced quality of life (QoL). Intravenous immunoglobulin (IVIG) therapy improves the well being of PIDD patients; however, the need for venous access and potentially severe side effects frequently require administration in medical facilities. We evaluated the long-term (12-month) experience with home-based self infusions of subcutaneous immune globulin (SCIG) in patients with PIDD on health-related QoL, rates of serious bacterial infections, and all other infections.


Methods: Adults (n = 42) and children (n = 9) with PIDD, previously treated with clinic-based IVIG, were trained to self administer SCIG at home. QoL (SF-36® and CHQ-PF50 questionnaires), serious bacterial infections, serum immunoglobulin G (IgG) levels, overall infections, and incidence of adverse events were recorded at predetermined intervals.


Results: All patients had improved perceptions of general health (adults P = 0.047, children P = 0.037). Adults also had marked improvement in the bodily pain and vitality assessments, and parents had improved perceptions of personal and family activities. Serum IgG levels were maintained at mean levels 25% higher than previous troughs on IVIG. There were 162 infections overall for an annual rate of 3.42/patient, but only 1 serious bacterial infection was observed (0.03/patient/yr). An average of 4.5 days/yr was missed from work or school per patient.


Conclusions: Home SCIG therapy was safe and led to improved perceptions of general health, higher serum IgG levels, and very low rates of infections and days missed from work/school.


Key Points


* Primary immunodeficiency diseases (PIDDs) include a large class of genetically heterogeneous disorders which predispose patients to significant risk of serious and chronic/recurrent infections, as well as reduced quality of life.


* Intravenous immunoglobulin (IVIG) therapy improves the well being of PIDD patients; however, side effects and severe reactions, as well as the need for venous access, frequently require administration under observation in medical facilities. Subcutaneous infusion of immunoglobulin G (SCIG) can be self administered at home with the aid of a portable syringe driver pump.


* Switching from IVIG to SCIG for 12 months improved perceptions of general health in both adults and children with PIDD, including marked improvement in bodily pain and vitality assessments. Days missed from work or school per patient were very few (4.5 days/patient/yr).


* Parents of children with PIDD had improved perceptions of personal and family activities.


* Serum immunoglobulin G (IgG) levels were maintained at a mean of 25% higher than historical trough levels. There was only a single serious bacterial infection, as well as very low annual rates of any infection (3.42/patient/yr).

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