Similar Efficacy with Use of Subcutaneous and Intravenous Immunoglobulin in CIDP and MMN: Meta-Analysis

Recent interest in the use of subcutaneous immunoglobulin (SCIG) in place of intravenous immunoglobulin (IVIG) for treatment of multifocal motor neuropathy (MMN) and chronic inflammatory demyelinating polyneuropathy (CIDP) prompted Canadian investigators to conduct a meta-analysis of published reports evaluating the efficacy and safety of the two IG treatment options for these chronic autoimmune neuropathies.

A total of eight studies comprising 50 patients with MMN and 88 patients with CIDP were included in the meta-analysis; six of the eight studies were conducted prospectively. There were no significant differences in muscle strength outcomes in MMN and CIDP with use of SCIG in lieu of IVIG. For MMN, the effect size was 0.65 (95 percent confidence interval [CI], -0.31 to 1.61) and for CIDP, the effect size was 0.84 (95 percent CI,-0.01 to 1.69).Additionally, administration of SCIG was associated with a 28 percent reduction in relative risk of moderate (e.g., fever, headache, nausea) and/or systemic adverse effects (95 percent CI, 0.11 to 0.76).

“Based on its comparable efficacy and seemingly better safety profile, SCIG could be considered as a valid alternative to IVIG in patients with CIDP and MMN, particularly patients who experience frequent fluctuations or cannot tolerate IVIG despite adjustments to the frequency and doses of infusion,” the investigators concluded.