Subcutaneous immunoglobulin treatment with ideal and protective levels of serum IGG levels and quality of life assessment

INTRODUCTİON AND PURPOSE: Most patients with primary and secondary immunodeficiency need regular intravenous immunoglobulin or subcutaneous immunoglobulin (SCIG) treatment. In recent years, subcutaneous administration has become more preferred by physicians due to the fact that it is faster and has less side effects. By SCIG administration ; fluctuation of serum IgG levels can be prevented and stable level can be maintained more easily. As a result, a decrease in the frequency of infections and the frequency of referral to health institutions due to chronic diseases is observed. In this study; to switch to subcutaneous immunoglobulin administration in immundeficiency patients receiving regular intravenous immunoglobulin (IVIG) therapy; The aim of this study was to evaluate the effects of serum IgG trough levels, frequency of infection, frequency of severe bacterial infections, frequency and duration of hospitalization, duration of absence / absence of school, and quality of life. PATIENTS AND METHODS: In this study, 31 patients with immunodeficiency and after IVIG treatment followed by SCIG were evaluated retrospectively in Ege University Department of Child Immunology After the first treatment, 7 patients discontinued treatment and 24 patients continued SCIG treatment. The cases, age, diagnosis, current complications, frequency of infection, frequency of hospitalization, mean IgG value, school and work absenteeism were evaluated. Serum immunoglobulin values, duration of infection and absence of school / work were recorded during the SCIG treatment. At the beginning of treatment, 6th and 12th months Quality of Life Scale was used. The serum IgG trough level, frequency of infection, severity of infection, duration / number of hospitalization, quality of life of patients before and after SCIG treatment were compared. RESULTS: The study included 22 boys and 2 girls. Twenty-two cases were diagnosed with primary immunodeficiency and 2 cases with secondary immunodeficiency. The diagnostic distributions included protein-losing enteropathy (n = 2), CVID (n = 11), Bruton's disease (n = 2), combined immunodeficiency (n=12), LRBA deficiency (n = 2), APDS (n = 1), Di-George syndrome (n = 1), X'linked lymphoproliferative disease (n = 1), v TTC37 mutation (n = 1), Hyper IgE syndrome (n = 2). The mean age was 15.9 ± 7.60 years, the age of onset of IVIG was 6.83 ± 4.44, and the age of onset of SCIG was 14.1 ± 7.07 years. The most common indication for initiation of SCIG treatment was the long tranfusion period and the difficulty of access to the hospital. All patients undergoing SCIG treatment had disease-related complications. Growth growth retardation was 45%, bronchiectasis 50%, chronic sinutisis 12.5%, splenomegaly 16.7%, hepatomegaly 8.3%, autoimmunity 8.3%, lymphoproliferation 20.8%, chronic diarrhea 25%. On the application zone 20 local redness, pain, swelling developed, there were no systemic side effects. The mean IgG value was 640 ± 376.2 mg / dl in the last 1-year period before the SCIG treatment, on the other hand the mean IgG value was 852 ± 381.2 mg / dl. after 1 year treatment. In the last 1 year during the IVIG treatment; the frequency of infection was 4.95 ± 3.67, the rate of severe bacterial infection was 0.87 ± 1.96, the number of hospitalization was 0.62 ± 1.37, and the duration of nonattendance was 8 ± 22.7 days. in the first year after SCIG treatment; the frequency of infection was 1.70 ± 1.73, the rate of severe bacterial infection was 0.45 ± 0.97, the number of hospitalizations was 0.70 ± 1.9, and the duration of absenteeism was 3.67 ± 11.5 days. The number of severe bacterial infections, the duration / number of hospitalizations did not change, but the frequency of infections and the duration of absenteeism decreased. There was a significant increase in the quality of life score of the patients and their families. CONCLUSION: SCIG treatment can be used easily in patients with immunodeficiency and provides ideal and protective immunoglobulin levels and can be used more widely in cases with regular Ig replacement therapy. The use of SCIG offers patients the possibility of treatment in their home environment, thus increasing the patient's satisfaction and quality of life. We believe that low-volume high-concentration immunoglobulin preparations for subcutaneous administration will be of great benefit to patients in our country.