Subcutaneous Ig as Alternative to IVIG in Multifocal Motor Neuropathy

Weekly or twice-weekly infusions of subcutaneous immunoglobulin (SCIG) at home were able to maintain muscle strength in four of five patients with multifocal motor neuropathy (MMN) who were crossed over from IVIG maintenance therapy, according to Dutch investigators. However, this result occurred only when patients received a total dose of IgG antibody equivalent to their prior IVIG maintenance dose. In another group of four subjects given SCIG at 50 percent of their prior IVIG maintenance dose, all four experienced deterioration in grip strength, pinch strength and dexterity.

Local adverse events — most commonly swelling and redness at the injection site — were reported by all patients during their six-month monitoring period; the frequency of these non-serious events declined over time. Throughout 330 total treatments, just nine mild systemic adverse events (fever, malaise, palpitations and skin rash) were reported by three patients, all but two of which occurred in the first week of therapy. There were no reported serious adverse events. The authors concluded that SCIG and IVIG were equally effective in achieving stable muscle strength in four of five subjects given an equivalent dosage of IgG immunoglobulin, and treatment was generally welltolerated with only mild local and systemic adverse events.