fSCIG in Elderly Patients with PID or SID in Real Clinical Practice
The work of a team of German and Dutch authors presents data on the real clinical use of 10% subcutaneous immunoglobulin facilitated by hyaluronidase (fSCIG) in elderly patients with primary (PID) or secondary (SID) immunodeficiency.
Specifics of Immunodeficiencies in the Elderly
PID and SID represent groups of heterogeneous diseases characterized by the dysfunction of various components of the immune system. The most common manifestations of immunodeficiencies include impaired antibody production, making these patients more susceptible to infections. One of the solutions to this problem is immunoglobulin replacement therapy, often long-term depending on the etiology of the immunodeficiency.
Elderly individuals represent a very interesting group of immunodeficient patients. They account for up to 9% of all PID cases and have an increased risk of developing SID on the basis of lymphoproliferative diseases or exposure to chemotherapy or immunosuppressive therapy. It is also true that the number of elderly people with immunodeficiency is increasing globally. Another challenge for this group of patients is the presence of various comorbidities.
Studied Patient Group in Real Practice
The authors summarized retrospectively collected data from 16 patients over the age of 65 treated with fSCIG (all received at least one infusion of the product). Data were collected over a 2-year period in 4 treatment centers in Germany and the Netherlands.
The average age of the patients was 69.9 years, with 10 patients having PID and 6 having SID. The average duration of treatment from the start of fSCIG application was 1.6 years (range 0–2.7 years). 14 patients had previously received another type of replacement therapy. The most common comorbidities in these individuals were chronic obstructive pulmonary disease, arterial hypertension, coronary artery disease, asthma, and osteoporosis.
Results
The majority of infusions were administered by the patients themselves at home (69%), while others received the medication with the help of a nurse or family doctor. Individual doses ranged from 20 to 35 g every 3 to 4 weeks. Infusions were administered using a pump at a maximum rate of 300 ml/hour. Most patients also administered the product to one site they were accustomed to, usually the abdomen.
The overall average serum IgG level in patients receiving fSCIG was 10.0 g/l, which most attending physicians considered a satisfactory result.
The most commonly described local adverse events were redness, rash, or pain at the infusion site.
Conclusion
This work provided data from real clinical practice showing that fSCIG is an easily feasible and well-tolerated treatment option for elderly patients with immunodeficiency, including home administration. The application can be adjusted according to the current needs of the patient concerning infusion volume, treatment interval, and other factors affecting the method of treatment administration.
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Source: van Paassen P., Pittrow D., Schidegger C. et al. Use of recombinant human hyaluronidase-facilitated subcutaneous immunoglobulin in elderly patients. Immunotherapy 2020; 12 (2): 131–139, doi: 10.2217/imt-2019-0175.
VV-MEDMAT- 79611; preparation date 12/2022
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