Patients on IVIG Therapy for Neurological Disorders Successfully Transitioned to SCIG Therapy

Canadian investigators at Ottawa Hospital have reported a very high success rate with a nurse-led individualized program to facilitate a smooth transition in patients with neurological disorders from chronic intravenous immune globulin (IVIG) to subcutaneous immune globulin (SCIG) treatment. Recognizing a large injection volume can be overwhelming and a barrier to successful SCIG treatment, this program involved a lead nurse who provided two or more individual educational sessions on SCIG administration, established a written transition plan and liaised with physicians.

The mean prior IVIG treatment duration in 19 participating patients was 31.5 months (range four months to 98 months). Referral diagnoses included myasthenia gravis (n=9), multifocal motor neuropathy (MMN) (n=5), chronic inflammatory demyelinating polyneuropathy (n=4) and Lambert-Eaton myasthenic syndrome (n=1). All patients were initially able to switch to SCIG, with a retention rate of 17 out of 19 (89.5 percent) at six months and 15 out of 19 (78.9 percent) at 12 months.

Overall, 79 percent and 68.4 percent of patients perceived their neurological symptoms either did not change or improved at six months and 12 months, respectively. Two patients reverted back to IVIG treatment due to worsening of their symptoms at two months and three months, while two others required supplemental IVIG infusions. Three of the four patients who failed to stay on SCIG treatment alone had MMN. In addition, four of the six patients who reported worsening neurological symptoms had MMN; there were only five MMN patients participating in total. The investigators propose “the SCIG dosage could be too low in our MMN patients.”