Subcutaneous Immunoglobulin Is a Potential Alternative to Intravenous Immunoglobulin in CIDP

Hypothesizing that administration of subcutaneous immunoglobulin (SCIG) in patients is feasible, safe and effective, Danish investigators randomized 30 adult patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) on maintenance therapy with intravenous immunoglobulin (IVIG) to either SCIG at a dose corresponding to their pre-study IVIG dose or to subcutaneous saline given twice weekly or three times weekly for 12 weeks at home.

At the start and end of the trial, as well as two weeks before, isokinetic strength performance of four predetermined and weakened muscle groups was measured. Overall disability sum score (ODSS), 40-meter walking test (40-MWT), nine-hole-peg test, neurological impairment score (NIS), Medical Research Council (MRC) score and grip strength were also evaluated.

SCIG therapy was well tolerated in all 14 patients who received it. Six patients complained of mild side effects at the injection site. In the SCIG group, there was an increase in isokinetic muscle strength of 5.5 ± 9.5% (P < 0.05) as compared with a decline of 14.4 ± 20.3% (P < 0.05) in the placebo group; the difference between the two groups was statistically significant (P <0.01). Grip strength, ODSS, NIS, MRC and 40-MWT all improved following SCIG versus saline. The authors concluded that SCIG therapy is feasible, safe and effective, and seems an attractive alternative to IVIG.