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Impact of IVIG vs. SCIG on IgG trough level and infection incidence in primary immunodeficiency diseases: A systematic review and meta-analysis of clinical studies
Journal article   Open access   Peer reviewed

Impact of IVIG vs. SCIG on IgG trough level and infection incidence in primary immunodeficiency diseases: A systematic review and meta-analysis of clinical studies

Pragya Shrestha, Paras Karmacharya, Zhen Wang, Anthony Donato and Avni Y. Joshi
The World Allergy Organization journal, v 12(10), 100068
01 Oct 2019
DOI: https://doi.org/10.1016/j.waojou.2019.100068
PMID: 31641401
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.waojou.2019.100068View
Published, Version of Record (VoR) Open

Abstract

IgG trough IVIG PIDD Primary immunodeficiency disease SCIG
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.

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Web of Science research areas
Allergy
Immunology
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