Home-Based Subcutaneous Immunoglobulin Versus Hospital-Based Intravenous Immunoglobulin in Treatment of Primary Antibody Deficiencies: Systematic Review and Meta Analysis
Abstract
Immunoglobulin replacement by the subcutaneous route (SCIg) for the prophylactic treatment of primary or secondary antibody deficient patients has been introduced as an alternative to conventional intravenous administration (IVIg). This is a systematic review of all eligible studies comparing efficacy and safety of IVIg and SCIg. Retrospective and prospective cohort studies and randomized, controlled trials comparing SCIg to IVIg were identified from MEDLINE, EMBASE, CINAHL, AMED, CSR, ISI and Cochrane Database without restriction on publication date and language. If possible, meta-analysis was performed by using the Review Manager software. A total of 47 articles with 1,484 compared cases were reviewed. Subcutaneous immunoglobulin replacement achieved acceptable IgG trough level, low incidence of side effects, efficacy similar to IVIg infusions, better health related quality of life and treatment satisfaction, and faster functional recovery with less time off work. Because of the heterogeneity of the reports, meta-analysis had to be performed by random effect method for IgG trough levels [OR (odds ratio) = 1.00, range = 0.84-1.15; p < 0.01], infection rates (OR = 0.59, range = 0.36-0.97; p = 0.04), and adverse events (OR = 0.09, range = 0.07-0.11; p < 0.001), which showed significant preference of SCIg over IVIg. Based on the analysis of published reports, changing immunoglobulin replacement therapy from IVIg to SCIg may be of benefit to qualified patients with primary immunodeficiency. These advantages, having been demonstrated in numerous studies,make medical, practical and economic sense to consider switching patients with antibody deficiency from IVIg to SCIg.
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A systematic review comparing the efficacy and safety of IVIG and SCIG was conducted based on data from 1028 eligible patients receiving immunoglobulin replacement.
“A systematic review of studies comparing the efficacy and safety of IVIG and SCIG was conducted based on data from 1028 eligible patients receiving immunoglobulin replacement (67.7% were adults, 56.3% had a diagnosis of common variable immunodeficiency).”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [57]
The meta-analysis found infection rates with an odds ratio of 0.59 (range 0.36-0.97; p = 0.04) for SCIG versus IVIG.
“The meta-analysis was performed using a random-effects method for immunoglobulin trough levels (odds ratio (OR) 1.00, range 0.84–1.15; p < 0.01), infection rates (OR 0.59, range 0.36–0.97; p = 0.04), and adverse events (OR 0.09, range 0.07–0.11; p < 0.001), which showed a significant preference for SCIG over IVIG.”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [57]
SCIG resulted in less time off work compared with IVIG.
“Moreover, SCIG resulted in better health-related QoL and faster functional recovery with less time off work [57].”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [57]
SCIG resulted in better health-related quality of life compared with IVIG.
“Moreover, SCIG resulted in better health-related QoL and faster functional recovery with less time off work [57].”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [57]
The meta-analysis found immunoglobulin trough levels with an odds ratio of 1.00 (range 0.84-1.15; p < 0.01) for SCIG versus IVIG.
“The meta-analysis was performed using a random-effects method for immunoglobulin trough levels (odds ratio (OR) 1.00, range 0.84–1.15; p < 0.01), infection rates (OR 0.59, range 0.36–0.97; p = 0.04), and adverse events (OR 0.09, range 0.07–0.11; p < 0.001), which showed a significant preference for SCIG over IVIG.”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [57]
The meta-analysis showed a significant preference for SCIG over IVIG.
“The meta-analysis was performed using a random-effects method for immunoglobulin trough levels (odds ratio (OR) 1.00, range 0.84–1.15; p < 0.01), infection rates (OR 0.59, range 0.36–0.97; p = 0.04), and adverse events (OR 0.09, range 0.07–0.11; p < 0.001), which showed a significant preference for SCIG over IVIG.”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [57]
SCIG resulted in faster functional recovery compared with IVIG.
“Moreover, SCIG resulted in better health-related QoL and faster functional recovery with less time off work [57].”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [57]
The meta-analysis found adverse events with an odds ratio of 0.09 (range 0.07-0.11; p < 0.001) for SCIG versus IVIG.
“The meta-analysis was performed using a random-effects method for immunoglobulin trough levels (odds ratio (OR) 1.00, range 0.84–1.15; p < 0.01), infection rates (OR 0.59, range 0.36–0.97; p = 0.04), and adverse events (OR 0.09, range 0.07–0.11; p < 0.001), which showed a significant preference for SCIG over IVIG.”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [57]
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References 77 · Cited by 185
- Authors
- Abolhassani, H., Sadaghiani, M. S., Aghamohammadi, A., Ochs, H. D., & Rezaei, N.
- Affiliations
- Children's Medical Center (IR)
- Seattle Children's Hospital (US)
- Corresponding author
- Ochs, Hans D.
- Rezaei, Nima
- Venue
- Journal of Clinical Immunology
- Published
- 2012-06-23
- Volume
- 32
- Issue
- 6
- Pages
- 1180-1192
- ISSN
- 0271-9142 (ISSN-L)
- 1573-2592
- OpenAlex
- W2037581442
- Cited by
- 185
- References
- 77
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 14 · 2023: 11 · 2022: 20 · 2021: 15 · 2020: 15 · 2019: 9 · 2018: 11 · 2017: 12 · 2016: 19 · 2015: 14 · 2014: 17 · 2013: 8 · 2012: 1
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Monoclonal and Polyclonal Antibodies Research
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Keywords
- subcutaneous immunoglobulin, intravenous immunoglobulin, primary antibody deficiency, immunoglobulin replacement therapy, IgG trough levels, infection rate, adverse events, health-related quality of life, treatment satisfaction, functional recovery
- MeSH terms
- Humans, Immunoglobulin G, Immunization, Passive, Immunologic Deficiency Syndromes, Prospective Studies, Quality of Life, Retrospective Studies, Self Administration, Randomized Controlled Trials as Topic, Databases, Bibliographic, Immunoglobulins, Intravenous, Infusions, Subcutaneous
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