SCIG administration: A promising and patient convenient alternative for those receiving long-term IVIG

Abstract

Background: Intravenous immunoglobulin (IVIG) therapy has been used as antibody replacement therapy in primary immunodeficiency diseases (PID) for more than 50 years. In this study, we aimed to define IVIG usage and adverse reactions and complications in PID and explain how subcutaneous immunoglobulin (SCIG) replacement therapy is an alternative that improves the patient experience. In addition, the additional nursing responsibilities associated with this service were also identified.

Methods: Data and service satisfaction surveys for the last 10 years were reviewed from the Allergy and Immunology Division log registry for those on IVIG and SCIG.

Results: IVIG practice: Most patients currently on IVIG in our unit have PID. Adverse reactions occur during the initial 30 to 60 minutes of the infusion and are mild and self-limited. Infusion reactions are more likely to occur in patients receiving IVIG for the first time. Infusion-related complications included pyrogenic reactions, allergic reactions, and vasomotor symptoms. Complications reported in the literature such as the transmission of blood-borne pathogens and other serious complications, including thrombotic events, renal adverse events, and aseptic meningitis were never reported. Pyrogenic reactions occurred at a rate ≥ 100 mL/hr in at least 3 patients, and a slower infusion rate of ≤ 75 mL/hr mitigated this rate-related complication.

SCIG program: This program started in Qatar in 2017. Usually, the clinician assesses and evaluates several factors to help select candidates for this therapy, including the perceptions of inconvenience and/or pain of IV infusions, presence of difficult vein access, and other relevant clinical and social factors. Once training in the appropriate techniques has been accomplished (3–6 sessions), it is most often self-administered in the home setting by the patient or a parent for a child. Table 1 summarizes patients on SCIG.

Additional nursing responsibilities: The nursing role in subcutaneous IgG administration is primarily that of an educator and to help the patient/family become independent. This can be achieved by the assessment of appropriate patient selection for self-administration. Determining which patients are suitable include adequate patient education with return demonstration of the necessary skill set, monitoring parameters, educating patients about their medication, and providing educational resources and support.

Conclusion: SCIG administration can be a convenient alternative for patients with PID receiving long-term IVIG.

Table 1.

Demographic and clinical characteristics of patients with PID on SCIG

Demographic & Clinical Characteristics of pts receiving SCIG (Hizentra) In Qatar
Patient	Age (years)	Age at first symptoms (years)	Diagnosis	Dose (grams)	Frequency	Discontinued?	Reasons for discontinuation
Pt 1	24	18	SAD	12 g	weekly	No
Pt 2	29	15	CVID	10 g	weekly	No
Pt 3	55	24	CVID	8 g	weekly	No
Pt 4	30	10	CVID	8 g	Once in 6 days	No
Pt 5	37	18	CVID	12 g	weekly	No
Pt 6	19	10	XLA	20 g	weekly	No
Pt 7	21	12	PIDD	8 g	weekly	No
Pt 8	31	18	CVID	12g	weekly	No
Pt 9	48	32	SAD	8 g	Once in 5 days	No
Pt 10	51	38	SAD	8 g	weekly	No
Pt 11	40	34	PIDD	8 g	weekly	No
Pt 12	16	10	PIDD	25 g	q.4 weeks	No
Pt 13	28	14	CVID	30 g	q.4 weeks	No
Pt 14	53	36	SAD	12 g	weekly	No
Pt 15	43	21	2ry IDD	20 g	Once in 10 days	No
Pt 16	30	18	CVID	12 g	Once in 5 days	yes	swelling and subcutaneous nodules
Pt 17	49	32	SAD	8 g	Once in 6 days	yes	swelling and redness in the infusion site
Demographic and clinical characteristics of patients receiving SCIG (HyQvia) in Qatar
Pt 18	22	13	XLA	20 g	q.3 weeks	yes	local infection
Pt 19	52	39	SAD	30 g	q.2 weeks	yes	unavailability of SCIG
Pt 20	37	19	XLA	40 g	q.4 weeks	yes	unavailability of SCIG
Pt 21	30	12	PIDD	60 g	q.4 weeks	yes	unavailability of SCIG