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Immunomodulatory Therapy to Achieve Maximum Efficacy: Doses, Monitoring, Compliance, and Self-infusion at Home

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Abstract

Introduction

The Oxford Programme for Immunomodulatory Immunoglobulin Therapy has been operating since 1992 at Oxford Radcliffe Hospitals in the UK. Initially, this program was set up for patients with multifocal motor neuropathy or chronic inflammatory demyelinating poly-neuropathy to receive reduced doses of intravenous immunoglobulin (IVIG) in clinic on a regular basis (usually every 3 weeks). The program then rapidly expanded to include self-infusion at home, which monitoring showed to be safe and effective. It has been since extended to the treatment of other autoimmune diseases in which IVIG has been shown to be efficacious.

Methods

This review includes details of the program such as the training of patients, dosing with immunoglobulin, and monitoring and compliance for self-infusion at home, with cases to illustrate these points.

Results

In addition, the Evidence for efficacy and the effects of confounding morbidities will be are included described. More recently, subcutaneous immunoglobulin therapy (SCIG) has been used in several chronic autoimmune peripheral neuropathies and in epidermolysis bullosa acquisita, with equally good effect. Trials of SCIG in other autoimmune diseases are planned.

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References

  1. van Schaik IN, Winer J, de Hann R, Vemeulen M: Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst. Rev. 2002;(2):CD001797.

  2. Nobile-Orazio E, Cappellari A, Priori A. Multifocal motor neuropathy: current concepts and controversies. Muscle Nerve. 2005;31(6):663–80.

    Article  PubMed  Google Scholar 

  3. van Schaik IN, van den Berg LH, de Haan R, Vermeulen M: Intravenous immunoglobulin for multifocal motor neuropathy. Cochrane Database Syst. Rev. 2005;(2):CD004429.

  4. Léger JM, Viala K, Cancalon F, Maisonobe T, Gruwez B, Waegemans T, et al. Intravenous immunoglobulin as short- and long-term therapy of multifocal motor neuropathy: a retrospective study of response to IVIg and of its predictive criteria in 40 patients. J. Neurol. Neurosurg. Psychiatry. 2008;79(1):93–6.

    Google Scholar 

  5. Sewell WA, Brennan VM, Donaghy M, Chapel HM. The use of self infused intravenous immunoglobulin home therapy in the treatment of acquired chronic demyelinating neuropathies. J. Neurol. Neurosurg. Psychiatry. 1997;63(1):106–9.

    CAS  Google Scholar 

  6. Finsterer J. Treatment of immune-mediated, dysimmune neuropathies. Acta Neurol Scand. 2005;112(2):115–25.

    Article  CAS  PubMed  Google Scholar 

  7. Tayal U, Burton J, Dash C, Wojnarowska F, Chapel H. Subcutaneous immunoglobulin therapy for immunomodulation in a patient with severe epidermolysis bullosa acquisita. Clin Immunol. 2008;129(3):518–9.

    Article  CAS  PubMed  Google Scholar 

  8. Hughes RA. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy: the ICE trial. Expert Rev Neurother. 2009;9(6):789–95.

    Article  CAS  PubMed  Google Scholar 

  9. van der Pol W-L, Cats EA, van den Berg LH: Intravenous Immunoglobulin Treatment in Multifocal Motor Neuropathy. J Clin Immunol. 2010. doi:10.1007/s10875-010-9408-3.

  10. Lucas M, et al: Infection outcomes in patients with common variable immunodeficiency disorders: relationship to immunoglobulin therapy over 22 years. J. Allergy Clin. Immunol. In press.

  11. Kyle RA, Benson J, Larson D, Therneau T, Dispenzieri A, Melton III LJ, et al. IgM monoclonal gammopathy of undetermined significance and smoldering Waldenstrom's macroglobulinemia. ClinLymphoma Myeloma. 2009;9(1):17–8.

    Article  CAS  PubMed  Google Scholar 

  12. Eftimov F, Vermeulen M, de Haan RJ, van den Berg LH, Van Schaik. IN: Subcutaneous immunoglobulin therapy for multifocal motor neuropathy. J Peripher Nerv Syst. 2009;14(2):93–100.

    Article  CAS  PubMed  Google Scholar 

  13. Harbo T, Andersen H, Hess A, Hansen K, Sindrup SH, Jakobsen J. Subcutaneous versus intravenous immunoglobulin in multifocal motor neuropathy: a randomized, single-blinded cross-over trial. Eur J Neurol. 2009;16(5):631–8.

    Article  CAS  PubMed  Google Scholar 

  14. Schleinitz N, Jean E, Benarous L, Mazodier K, Figarella-Branger D, Bernit E, et al. Subcutaneous immunoglobulin administration: an alternative to intravenous infusion as adjuvant treatment for dermatomyositis? Clin. Rheumatol. 2008;27(8):1067–8.

    Google Scholar 

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Acknowledgements

We would like to thank clinical nurse specialists Nicki Brennan, Nicola Bentley, Janet Burton, Holly Hurst, and Carol Ross for their close involvement with the program; Drs. Michael Donaghy, David Hilton-Jones, Ralph Gregory, and Chris Fursdon-Davies in Clinical Neurology at the Oxford Radcliffe Hospitals for referring the patients; the staff of the Immunology Laboratory; the NIHR Biomedical Centre Programme and the Oxford Radcliffe Hospitals for funding. We are grateful to the patients for their willingness to learn self-infusion and their expertise to ensure the continuation of the program.

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Authors and Affiliations

  1. Department of Clinical Immunology, John Radcliffe Hospital, Level 4A, Academic Street, Headley Way, Oxford, UK, OX3 9DU

    Mary Lucas, Ken Hugh-Jones, Angela Welby, Siraj Misbah & Helen Chapel

  2. Department of Pharmacology, University of Berne, Berne, Switzerland

    Peter Spaeth

  3. Nuffield Department of Medicine, University of Oxford, Oxford, UK

    Helen Chapel

Authors
  1. Mary Lucas
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  2. Ken Hugh-Jones
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  3. Angela Welby
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  4. Siraj Misbah
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  5. Peter Spaeth
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  6. Helen Chapel
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Corresponding author

Correspondence to Helen Chapel.

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Lucas, M., Hugh-Jones, K., Welby, A. et al. Immunomodulatory Therapy to Achieve Maximum Efficacy: Doses, Monitoring, Compliance, and Self-infusion at Home. J Clin Immunol 30 (Suppl 1), 84–89 (2010). https://doi.org/10.1007/s10875-010-9400-y

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  • DOI: https://doi.org/10.1007/s10875-010-9400-y

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