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High-Dose Subcutaneous Immunoglobulin in Patients With Multifocal Motor Neuropathy: A Nursing Perspective
Vilija M Rasutis1, Hans D Katzberg, Vera Bril
1University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada (Dr Bril); University Health Network/Toronto General Hospital, Toronto, Ontario, Canada (Dr Katzberg); and University of Toronto, Toronto, Ontario, Canada (Drs Bril and Katzberg, Ms Rasutis). Vilija M. Rasutis, BScN, RN, is a clinical and research nurse with expertise in infusion therapy and home care nursing. From 2011 to 2016, she was a clinical research coordinator and infusion nurse at Toronto General Hospital's neuromuscular clinic. Her research interests are focused on home intravenous immunoglobulin infusion and subcutaneous immunoglobulin for the treatment of immune neuromuscular conditions. Ms Rasutis is currently a safety reviewer for the global drug safety/study start-up team at Shire in Chicago, Illinois. Hans D. Katzberg, MD, FRCP(C), is a neuromuscular specialist and clinical investigator at the University Health Network/Toronto General Hospital and an assistant professor of neurology at the University of Toronto. His research focus is on outcome measures and clinical trials in immune-mediated neuromuscular junction disorders, including intravenous and subcutaneous treatments for these conditions. Vera Bril, MD, is a professor of medicine (neurology) at the University of Toronto and the director of neurology of the University Health Network and at Mount Sinai Hospital. She holds the Krembil Family Chair in Neurology, the research arm of Toronto Western Hospital and a division of the University Health Network. Dr Bril is also interim director of the Krembil neuroscience program at University Health Network. She has expertise in the diagnosis and management of patients with complex neuromuscular disorders, including evidence-based treatment of myasthenia gravis and inflammatory polyneuropathies.
Multifocal motor neuropathy (MMN), an immune neuromuscular condition causing progressive weakness, usually responds to immune-mediated treatments, including intravenous immunoglobulin (IVIG). Fifteen patients with MMN receiving IVIG were enrolled in an open-label, single-center trial and switched to 20% subcutaneous immunoglobulin (SCIG) using a smooth transition protocol (ie, changing the therapy without interruption or impact on the intended outcome of the therapy). Patients received individualized training and support based on motivation and ability to learn, follow directions, and maintain compliance. Although some patients required assistance during the training phase, most managed self-infusion and reported satisfaction in managing therapy autonomously. Educating patients with neuropathies to self-infuse high-dose SCIG at home and with flexibility in dosing schedules was successfully demonstrated in this patient group.
Multifocal motor neuropathy (MMN), an immune neuromuscular condition causing progressive weakness, usually responds to immune-mediated treatments, including intravenous immunoglobulin (IVIG). Fifteen patients with MMN receiving IVIG were enrolled in an open-label, single-center trial and switched to 20% subcutaneous immunoglobulin (SCIG) using a smooth transition protocol (ie, changing the therapy without interruption or impact on the intended outcome of the therapy). Patients received individualized training and support based on motivation and ability to learn, follow directions, and maintain compliance. Although some patients required assistance during the training phase, most managed self-infusion and reported satisfaction in managing therapy autonomously. Educating patients with neuropathies to self-infuse high-dose SCIG at home and with flexibility in dosing schedules was successfully demonstrated in this patient group.
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