Different brands of intravenous immunoglobulin for primary immunodeficiencies: how to choose the best option for the patient?

Abstract

Immunoglobulin (IG) replacement therapy has served as lifesaving treatment in primary immunodeficiency diseases (PID) for more than six decades. Approximately 70% of patients with PID require IG replacement to maintain their health during the course of disease. It is estimated that about one-third of IG products is used for replacement therapy in these patients. On the other hand, the introduction of newer IG preparations is continuing to improve and extend the quality of life in PID patients. Because of the options available including concentrations, formulations, osmolality, product stabilizers, sodium concentration, anti-infective activity, IgA content and pH, it is important to match the PID patient’s complications with potential side effects associated with the composition of a particular IG product. The purpose of this review is to present the clinical differences of intravenous IG among the various preparations regarding PID patients.

Keywords:

• formulations
• intravenous immunoglobulin
• primary immunodeficiency disease
• risk factors

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The convenient IGIV formulation for use is liquid because they come as pre-made solutions, no time is required for their reconstitution, and the extra amount can be stored. However, the lyophilized preparation concentrations range from 3 to 12% and thus desired concentrations can be prepared without the need for storing the extra amount.

• The effect of IGIV as an immune modulator should be considered in PID patients with comorbidity of autoimmunity or inflammatory disorders according to the attributed evidence-based protocols.

• Several parameters can modulate the infusion rate of IGIV in PID patients, including concentration of product, company-recommended infusion and total volume based on the clinical condition of the patient, especially bronchiectasis, enteropathy, obesity and pregnancy.

• Manufacturing process and composition of IGIV products are the main part of training of caregivers dealing with PID patients as they may affect tolerability, adverse effects and clinical outcomes directly.