Impact of subcutaneous immunoglobulin on quality of life in patients with chronic inflammatory demyelinating polyneuropathy previously treated with intravenous immunoglobulin.

Vu, Tuan; Anthony, Natalie; Alsina, Raul; Harvey, Brittany; Schleutker, Allison; Farias, Jerrica; Dang, Samuel; Suresh, Niraja; Gooch, Clifton

INTRODUCTION/AIMS Intravenous immunoglobulin (IVIg) is a common therapy for patients with chronic inflammatory demyelinating polyneuropathy (CIDP). IVIg may cause systemic adverse events (AEs); therefore, infusion of subcutaneous immunoglobulin (SCIg) may be preferred by some patients. Here, we document experiences of patients transitioning from IVIg to SCIg. METHODS Transitioning subjects with CIDP were followed in a 6-month prospective, open-label study. Primary endpoint was the percentage of subjects who withdrew for any reason (including significant AEs). Secondary endpoint was symptom progression or relapse requiring a change in management. Quality of life (QOL) and treatment satisfaction were assessed using the Short Form (SF)-36 Health Survey, Treatment Satisfaction Questionnaire for Medication (TSQM), and Chronic Acquired Polyneuropathy Patient-Reported Index (CAP-PRI). Efficacy was assessed using the Inflammatory Rasch-built Overall Disability Scale (I-RODS), hand-held dynamometry (HHD), limb motor strength testing (LMST), and timed 25-ft walk (T25-FW). RESULTS Fifteen CIDP subjects transitioned from IVIg to SCIg. Of these, three (20%) met the primary endpoint and one (7%) met the secondary endpoint. The SF-36 showed a statistically significant improvement for the role limitations physical domain after 24 weeks (p = 0.03) with no significant differences observed in other domains. TSQM and CAP-PRI showed significant differences in favor of SCIg (p = 0.003 and 0.02, respectively). No significant differences were observed in efficacy after 24 weeks, except for LMST which favored SCIg (p = 0.003). Eight of the 12 study completers (67%) continued with SCIg. DISCUSSION Transition to SCIg was associated with maintained efficacy and improved QOL.