Prophylactic immunoglobulin therapy in secondary immune deficiency – an expert opinion

ABSTRACT

Introduction: In primary immunodeficiency (PID), immunoglobulin replacement therapy (IgRT) for infection prevention is well-established and supported by a wealth of clinical data. On the contrary, very little evidence-based data is available on the challenges surrounding the use of IgRT in secondary immune deficiencies (SID), and most published guidelines are mere extrapolations from the experience in PID.

Areas covered: In this article, four European experts provide their consolidated opinion on open questions surrounding the prophylactic use of IgRT in SID, based on their clinical experience. The main topics are IgRT initiation, route of administration, dose optimization, and therapy discontinuation. The authors hope this discussion will be of assistance to practicing physicians in their daily decision-making.

Expert commentary: Although growing experience indicates that IgRT could play an important role in the management of SID, very little robust evidence is available to guide clinical practice. The authors stress the urgent need for new studies in the field and discuss points they find of importance to design them adequately.

KEYWORDS:

• Secondary immune deficiencies
• immunoglobulin replacement
• IVIG
• SCIG
• fSCIG
• expert opinion
• recommendations

Declaration of interest

All authors report personal fees from Baxalta, in the context of a Scientific Advisory Board meeting. E Kimby also received personal fees from Celgene, Pharmacyclics, Jansen, Gilead, and Mundipharma, and has benefitted from research grants from Roche and Pfizer. C Agostini also received personal fees from CSL Behring, Intermune, Roche, Boehringer, and Novartis, and has benefited from research grants from Baxalta and CSL Behring. Medical writing and editorial support for this paper was provided by Dr Nathalie Preiswerk from Medicalwriters.com (Zurich, Switzerland), and funded by Baxalta. The authors have no other 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 apart from those disclosed.

Additional information

Funding

This paper was funded by Baxalta GmbH.