Subcutaneous immunoglobulin treatment in CIDP and MMN. Efficacy, treatment satisfaction and costs

J Neurol Sci. 2017 Jul 15:378:19-25. doi: 10.1016/j.jns.2017.04.039. Epub 2017 Apr 24.

Abstract

Subcutaneous administration of immunoglobulin (SCIG) in chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) has been reported in several case reports and in a few randomized trials during the last decade. In this review we present the studies on SCIG in CIDP and MMN with special focus on the clinical effects. Moreover, the effect on quality of life, side effects to SCIG and the health economic perspectives are reviewed. Nine case studies, three randomized trials and six long-term, follow-up studies were identified. Most of the studies are conducted in patients switched from regular IVIG to SCIG treatment; one study involves treatment-naïve patients. The review shows that none of the studies have been powered to demonstrate an effect on disability. SCIG can maintain muscle strength for a period of 1 to 2years and ability seems preserved for a similar period. Quality of life is generally unchanged or improved after switch to SCIG and generalized side-effects seem fewer, whereas local reactions at the injection site occur. Health economic analyses favour SCIG at the doses used in the reviewed studies.

Keywords: Chronic inflammatory demyelinating polyneuropathy; Multifocal motor neuropathy; Subcutaneous immunoglobulin quality of life.

Publication types

  • Review

MeSH terms

  • Humans
  • Immunization, Passive
  • Immunoglobulin Isotypes / administration & dosage*
  • Immunoglobulin Isotypes / adverse effects
  • Immunoglobulin Isotypes / economics
  • Immunologic Factors / administration & dosage*
  • Immunologic Factors / adverse effects
  • Immunologic Factors / economics
  • Infusions, Subcutaneous
  • Motor Neuron Disease / drug therapy
  • Motor Neuron Disease / economics
  • Motor Neuron Disease / therapy*
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / economics
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / therapy*
  • Subcutaneous Absorption

Substances

  • Immunoglobulin Isotypes
  • Immunologic Factors