Lifelong Need for IG? Weighing the Pros and Cons
There is some debate among immunologists as to whetherIG therapy prescribed to treat adults diagnosed with immunedeficiencies should be temporarily halted to determine its necessity. Here, two experts present their sides of the issue.
Patients and doctors have reported that many insurance companies have adopted a policy to require all patients diagnosed with hypogammaglobulinemia, subclass deficiency or selective antibody deficiency to trial off of immunoglobulin (IG) therapy after a year of treatment in order to reassess its necessity. There is some research to support this policy. For instance, studies show that the immune systems of pediatric patients may need time to mature and, therefore, trialing these patients off IG to reassess their innate immune systems may be reasonable. Likewise, it has been reported that some patients who have dealt with a long-term disease may simply need to rest their immune system to give it a chance to heal and repair itself. Similar to the support of a crutch for a broken limb, the body uses the passive immunity provided by IG so that the immune system can rest and repair itself. Regardless, even expert clinical immunologists have a difference of opinion on the subject. Therefore, having a one-size-fits-all approach may not be in the best interest of the patient.
For this article, we invited two expert immunologists to present their analyses, pro versus con, on the issue of whether adults diagnosed with these immunodeficiency diseases should trial off IG after a period of therapy.
A Debate Among Shades of Gray
As these two experts so expressly convey in their analyses, this issue of lifelong need for IG is far from black and white. Instead, whether pro or con, the grays in their lines of thinking come across explicitly: Determining when to treat primary immunodeficiency patients with IG must be based upon a proper diagnosis, severity of infections, patient response and the doctors’ expertise.
No doubt, this debate represents just one of many differences of opinion that patients and immunologists will have concerning treatment with IG therapy. In the relatively young field of study of primary immunodeficiencies, the understanding of how and why IG treatment is and is not effective will continue to evolve.
RICARDO U. SORENSEN, MD, is professor and head of the Jeffrey Modell Center for Immunodeficiencies, Louisianan State University Health Science Center, New Orleans, La.
FRANCISCO A. BONILLA, MD, is an assistant professor at Harvard Medical School, Boston, Mass., and program director of clinical immunology, assistant in medicine at Children’s Hospital Boston.
Editor’s note: This article refers to both IG and IgG. To clarify: IG is used when referring to the immune globulin therapy (the drug used to treat an immune deficiency). IgG is used when referring to the specific antibody found in the body that immune deficient patients are lacking.