Intravenous versus Subcutaneous Immunoglobulin in Primary Immunodeficiency: Real-World Evaluation of Safety, Efficacy, and Patient Perceptions

Abstract

Background: Patients with primary immunodeficiency disorders (PIDD) typically require life-long immunoglobulin (IG) replacement therapy. There are two routes of IG administration: intravenous (IVIG) and subcutaneous (SCIG). To better understand routes of IG administration in the real-world, use in a home infusion setting was evaluated. Objective: To evaluate the safety, efficacy, and perceived responses in PIDD patients on IVIG versus SCIG in a realworld, home infusion setting. Methods: Retrospective data were collected from 2010 to 2018 from a national home infusion pharmacy of PIDD patients receiving IVIG or SCIG therapy for at least 6 months with evaluations for safety, efficacy, and patient perception of response. Results: A total of 149 patients were identified for analysis: IVIG (n=84) and SCIG (n=65). Overall, patients in the SCIG group had higher rates of local adverse reactions, while patients receiving IVIG had higher rates of systemic adverse reactions. Both SCIG and IVIG were effective as the majority of patients had ≤ 1 infection or hospital visit within the study period. However, patients in the SCIG group had fewer hospital visits and lower rates of infections overall. Patients receiving SCIG also perceived a faster speed of response. Conclusion: SCIG infusions are safe, efficacious, and well tolerated when compared to IVIG, providing PIDD patients with an alternative route of IG administration. Notably, hospital visits and infection rates were significantly reduced in patients receiving SCIG. The overall findings of this study contribute to growing evidence that demonstrates the benefits of SCIG in adult and pediatric patients with PIDD.