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Switch from Intravenous to Subcutaneous Immunoglobulin in CIDP and MMN: 12 Months Results from an Observational Study
Stefan Gingele1, Anna Christina Saparilla Pietschmann2, Konstantin F Jendretzky2
1Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. gingele.stefan@mh-hannover.de.
Introduction:
Since 2018 subcutaneous immunoglobulin (SCIg) has been approved for the maintenance treatment of chronic inflammatory demyelinating polyneuropathy (CIDP). However, comprehensive real-world data for long-term SCIg treatment are scarce for CIDP and especially for other immune-mediated neuropathies such as multifocal motor neuropathy (MMN).
Methods:
In this observational study, 62 patients with CIDP and 13 with MMN were analyzed. Patients had been receiving regular intravenous immunoglobulin (IVIg) and transitioned to an equivalent weekly dose of SCIg. A comprehensive set of biographical, clinical, and paraclinical data were compared between the time of the switch and after 12 months.
Results:
Subcutaneous administration was continued by 84% of the patients with CIDP and 77% of the patients with MMN for at least 12 months. Patients were clinically and electroneurographically stable over a period of 12 months under SCIg therapy and treatment satisfaction and preference was high. Nevertheless, intensified treatment especially by increasing the SCIg dose was necessary in a relevant proportion of both groups (31% of patients with CIDP and 40% of patients with MMN). The proportion of patients with concomitant autoimmune disease was higher in patients with CIDP with intensified treatment.
Conclusions:
SCIg is an effective alternative maintenance treatment for patients with CIDP and MMN who have previously responded to IVIg. Switching to an equivalent weekly dose of SCIg as a replacement for monthly IVIg is both feasible and effective in most patients. Nevertheless, about one-quarter of patients require an increased dose of subcutaneous immunoglobulin, which is well tolerated and often preferred to allow continuation of this treatment modality.
