Abstract
PurposeImmunoglobulin (Ig) replacement therapy is an important life-saving treatment modality for patients with primary antibody immune deficiency disorders (PAD). IVIG and SCIg are suitable alternatives to treat patients with PAD but vary in key ways. Existing evidence on patient preferences for Ig treatments given the complexities associated with IVIG and SCIg treatment is limited and fails to account for variations in preferences across patients. For this reason, we sought to evaluate PAD patient preferences for features of IVIG and SCIg across different patient characteristics.Materials and Methods119 PAD patients completed a discrete-choice experiment (DCE) survey. The DCE asked respondents to make choices between carefully constructed treatment alternatives described in terms of generic treatment features. Choices from the DCE were analyzed to determine the relative influence of attribute changes on treatment preferences. We used subgroup analysis to evaluate systematic variations in preferences by patients’ age, gender, time since diagnosis, and treatment experience.ResultsPatients were primarily concerned about the duration of treatment side effects, but preferences were heterogeneous. This was particularly true around administration features. Time since diagnosis was associated with an increase in patients’ concerns with the number of needles required per infusion. Also, patients appear to prefer the kind of therapy they are currently using which could be the result of properly aligned patient preferences or evidence of patient adaptive behavior.ConclusionsHeterogeneity in preferences for Ig replacement treatments suggests that a formal shared decision making process could have an important role in improving patient care.
Highlights
IntroductionImmunoglobulin (Ig) replacement therapy is an important lifesaving treatment modality for patients with primary antibody immune deficiency disorders (PAD), especially those with antibody deficiency that account for approximately 50% of all types of primary immune deficiency disorders
Patients appear to prefer the kind of therapy they are currently using which could be the result of properly aligned patient preferences or evidence of patient adaptive behavior
Immunoglobulin (Ig) replacement therapy is an important lifesaving treatment modality for patients with primary antibody immune deficiency disorders (PAD), especially those with antibody deficiency that account for approximately 50% of all types of primary immune deficiency disorders
Summary
Immunoglobulin (Ig) replacement therapy is an important lifesaving treatment modality for patients with primary antibody immune deficiency disorders (PAD), especially those with antibody deficiency that account for approximately 50% of all types of primary immune deficiency disorders. Intramuscular gammaglobulin was first used in the early 1950s as replacement therapy until intravenous immunoglobulin (IVIG) was approved in 1981. This was a notable advancement since IVIG could essentially normalize the serum levels of IgG, and more productively protect patients from infection and even chronic lung disease. Gardulf et al [1] and Ochs et al [2] showed that the subcutaneous route for Ig replacement therapy, e.g. SCIg was safe, well tolerated, and effective in achieving adequate serum IgG levels. In a multicenter study of 165 patients with hypogammaglobulinemia receiving subcutaneous infusions (27,030 at home) a significant reduction in adverse systemic reactions was observed compared with intramuscular or intravenous administration. SCIg is a suitable alternative to IVIG and may present certain opportunities for optimizing at-home care for patients with PAD [3]
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