Immunoglobulin Replacement Therapy Versus Antibiotic Prophylaxis as Treatment for Incomplete Primary Antibody...

Area of Science:

• Immunology
• Clinical Medicine

Background:

• Patients with IgG subclass deficiency (IgSD) and specific polysaccharide antibody deficiency (SPAD) frequently experience recurrent infections.
• Previous studies suggested prophylactic antibiotics (PA) and immunoglobulin replacement therapy (IRT) efficacy, but lacked prospective validation.

Purpose of the Study:

• To prospectively compare the efficacy of PA and IRT in preventing infections in patients with IgSD ± SPAD through a randomized crossover trial.

Main Methods:

• A randomized crossover trial involving 64 patients (IgSD ± SPAD) was conducted.
• Patients received 12 months of PA followed by 12 months of IRT, or vice versa, with a 3-month bridging period.
• Efficacy was measured by infection incidence, and adverse events were compared between treatment arms.

Main Results:

• Overall efficacy of PA and IRT did not significantly differ (p=0.58).
• PA was associated with a lower proportion of related adverse events compared to IRT (26.8% vs. 60.3%, p<0.0003).
• Patients experiencing persistent infections on PA showed a significant reduction in infections after switching to IRT (2.63 vs. 0.64 infections/year, p<0.01).

Conclusions:

• IRT and PA demonstrate comparable efficacy in managing infections in IgSD ± SPAD patients.
• Patients with persistent infections during PA treatment benefited from subsequent IRT.
• Considering costs and side effects, IRT should be reserved for patients with persistent infections unresponsive to PA.