Immunoglobulin replacement therapy (IRT) has an important role in minimising infections and improving the Health Related Quality of Life (HRQoL) in patients with immunodeficiency, who would otherwise experience recurrent infections. These plasma derived products are available as intravenous immunoglobulin (IVIg) or subcutaneous immunoglobulin (SCIg). The global demand for these products is growing rapidly and has placed pressure on supply. Some malignancies and their treatment (as well as other medical therapies) can lead to secondary hypogammaglobulinaemia or secondary immunodeficiency (SID) requiring IRT. While IVIg use in this cohort has well established therapeutic benefits, little is known about SCIg use. A literature search in June 2015 found only seven published manuscripts on SCIg use. These papers found that both IRT modes had equivalent efficacy in regards to reduction of bacterial infections. In addition, SCIg was reported to produce higher serum IgG trough levels compared to IVIg on equivalent dosage with the added benefit of fewer side effects. Patient HRQoL reports demonstrate preference for SCIg, because of reduced side effects and hospital visits. There are no Health Economic models published on SCIg use in SID, but models on primary immunodeficiency disease and IRT conclude that SCIg provided greater economic benefits than IVIg. The findings of this small number of reports suggest that SCIg therapy for patients with SID is likely to be beneficial for both the patient and healthcare providers. To substantiate wider use of SCIg in SID, larger and more detailed studies are needed to accurately quantify the effectiveness of SCIg.
Transfusion Medicine Reviews / Vol. 31, No. 1, pp.45-50