Abstract
BackgroundPatients with primary immunodeficiency disease (PIDD) and antibody deficiency require lifelong immunoglobulin replacement therapy. While both subcutaneous immunoglobulin (SCIG) and intravenous immunoglobulin (IVIG) replacement therapy are effective in preventing infection, patients with PIDD still experience worse health-related quality of life (hrQOL) outcomes.ObjectiveAssess differences in hrQOL for PIDD patients receiving home SCIG versus IVIG.MethodsSF-36 surveys were administered by a specialty pharmacy to 630 PIDD patients receiving home SCIG and IVIG at baseline and then every 3 months between 2014 and 2016. Results were analyzed using two-sample t tests and linear mixed effects model. Analysis was repeated for different age categories and trended over time.ResultsPatients receiving SCIG reported statistically significant higher energy fatigue scores (+ 9 points, p < 0.001) but lower perceived role limitations due to physical health scores (− 14 points, p < 0.001). These differences were only observed in patients > 36 years of age. There were no differences in the composite SF-36 score for patients receiving SCIG versus IVIG (+ 1, p = 0.66). Immunoglobulin-naïve patients all improved their hrQOL, but a larger improvement was seen in those initiating SCIG versus IVIG.ConclusionPatients with PIDD on home IVIG versus SCIG have similar composite hrQOL scores as measured by the SF-36. In the adult population, initiating immunoglobulin replacement with SCIG may result in more hrQOL improvement compared with IVIG, although personal preferences should also be considered.Clinical ImplicationsPatients with PIDD on home IVIG versus SCIG have similar composite health-related quality of life scores as measured by the SF-36.Capsule SummaryPatients with primary immune-deficiency on home IVIG versus SCIG have similar composite health-related quality of life scores as measured by the SF-36. Personal preferences are important in deciding whether to treat with IVIG or SCIG.
Highlights
Patients with primary immunodeficiency disease (PIDD) and antibody deficiency require lifelong immunoglobulin replacement therapy
To investigate differences in quality of life scores for patients on home subcutaneous immunoglobulin (SCIG) versus intravenous immunoglobulin (IVIG) across the 8 domains of the SF-36 and using a composite score, we first used a two-sample t test to compare scores averaged within subject
We used a linear mixed effects regression model to leverage information from multiple SF-36 results within each subject including only a fixed effect for whether the subject was on SCIG vs IVIG and again found a statistically significant higher reporting of energy fatigue scores (+ 9 points, p < 0.001) and lower reporting of perceived role limitations due to physical health scores (− 14 points, p < 0.001) (Fig. 4)
Summary
Patients with primary immunodeficiency disease (PIDD) and antibody deficiency require lifelong immunoglobulin replacement therapy. While both subcutaneous immunoglobulin (SCIG) and intravenous immunoglobulin (IVIG) replacement therapy are effective in preventing infection, patients with PIDD still experience worse health-related quality of life (hrQOL) outcomes. Primary immunodeficiency disease (PIDD) is a group of over 300 diseases characterized by defects within the immune system. Immunoglobulin replacement is a mainstay of therapy for the majority of patients with antibody deficiencies. Immunoglobulin replacement is administered by the intravenous route (IVIG) or subcutaneous route (SCIG) to return immunoglobulin levels to physiologic levels [1,2,3]. IVIG is administered approximately once per month by a licensed healthcare professional either at an infusion center or through home healthcare with an infusion nurse.
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