IVIG to SCIG Switch in CIDP & MMN Patients: Improved Tolerability and Patient Satisfaction

Eight consecutive patients on long-term, hospital-based intravenous immunoglobulin (IVIG) therapy to treat chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) (n=4) and multifocal motor neuropathy (MMN) (n=4) were switched to home-based subcutaneous immunoglobulin (SCIG). Patients were selected on the basis of a relatively low dosing requirement, problems experienced with IVIG, and their willingness to switch to SCIG. Reasons cited for wishing to switch from IVIG included adverse effects attributable to IVIG (neutropenia, n=3; nausea or headache, n=2; allergy requiring treatment, n=1); unacceptable fluctuations in weakness as IVIG wore off (n=1); poor intravenous access (n=2); distance from home to hospital (n=2); and missing work for hospital visits (n=1). Several patients cited more than one reason.

After a mean of 33 months on SCIG therapy (range 18 to 64 months), seven patients remained neurologically stable, with six on a similar mean weekly immunoglobulin dose relative to their original IVIG dose. At final follow-up, the mean weekly SCIG dose ranged from 8.0 grams to 24.0 grams.

Seven of the eight patients reported a “good” outcome, citing substantial benefits relating to nausea and headache (four patients), travel convenience (four patients), venous access problems (three patients) and avoidance of wearing-off fluctuations (two patients). Adverse effects of SCIG were generally mild and infrequent. The mean score in response to the question “Overall how strong is your preference for IVIG or SCIG?” (visual analogue scale [VAS]; prefer IVIG = 0, prefer SCIG = 100) was 93 (standard deviation, 7). For seven of the eight patients, the investigators concluded that “SCIG gave improved tolerability and patient satisfaction with similar efficacy compared with IVIG.”