Open access

A clinical trial protocol to evaluate the safety and pharmacokinetics of subcutaneously administered immunoglobulin in patients with primary immunodeficiency

Publication: LymphoSign Journal
22 May 2019

Abstract

This protocol is excerpted from recent clinical trials used to study the pharmacokinetics, safety, and tolerability of subcutaneously administered immunoglobulin (SCIG) in subjects with primary immunodeficiency. The primary objective is to determine the weekly dose of SCIG product that produces a steady-state area under the concentration-time curve of total immunoglobulin G level that is non-inferior to that of regularly administered intravenous immunoglobulin (IVIG). We include details of the target population, eligibility criteria, treatment phases, key assessments and procedures, and study analyses. Given that IVIG may be problematic in patients with poor venous access or those who develop systemic adverse effects, among others, the development of SCIG for use in the home setting provides an alternative treatment technique for adults and children with primary immunodeficiency.
Statement of novelty: This protocol describes the main topics found in prospective clinical studies evaluating the safety and pharmacokinetics of SCIG in subjects with primary immunodeficiency.

Formats available

You can view the full content in the following formats:

REFERENCES

Berger M. and Allen J.A. 2015. Optimizing IgG therapy in chronic autoimmune neuropathies: A hypothesis driven approach. Muscle Nerve. 51:315–326.
Berger M., Rojavin M., Kiessling P., and Zenker O. 2011. Pharmacokinetics of subcutaneous immunoglobulin and their use in dosing of replacement therapy in patients with primary immunodeficiencies. Clin. Immunol. 139:133–141.
Berger M., Jolles S., Orange J.S., and Sleasman J.W. 2013. Bioavailability of IgG administered by the subcutaneous route. J. Clin. Immunol. 33:984–990.
Bonilla F.A. and Geha R.S. 2003. 12. Primary immunodeficiency diseases. J. Allergy Clin. Immunol. 111:S571–S581.
Bruton O.C. 1952. Agammaglobulinemia. Pediatrics. 9:722–728.
Ochs H.D., Gupta S., Kiessling P., Nicolay U., Berger M., and the Subcutaneous IgG Study Group. 2006. Safety and efficacy of self-administered subcutaneous immunoglobulin in patients with primary immunodeficiency diseases. J. Clin. Immunol. 26:265–273.
Orange J.S., Belohradsky B.H., Berger M., Borte M., Hagan J., Jolles S., Wasserman R.L., Baggish J.S., Saunders R., and Grimbacher B. 2012. Evaluation of correlation between dose and clinical outcomes in subcutaneous immunoglobulin replacement therapy. Clin. Exp. Immunol. 169:172–181.
Picard C., Al-Herz W., Bousfiha A., Casanova J.L., Chatila T., Conley M.E., Cunningham-Rundles C., Etzioni A., Holland S.M., Klein C., Nonoyama S., Ochs H.D., Oksenhendler E., Puck J.M., Sullivan K.E., Tang M.L., Franco J.L., and Gaspar H.B. 2015. Primary immunodeficiency diseases: An update on the classification from the International Union of Immunological Societies Expert Committee for Primary Immunodeficiency 2015. J. Clin. Immunol. 35:696–726.
Radinsky S. and Bonagura V.R. 2003. Subcutaneous immunoglobulin infusion as an alternative to intravenous immunoglobulin. J. Allergy Clin. Immunol. 112:630–633.
Resnick E.S. and Cunningham-Rundles C. 2012. The many faces of the clinical picture of common variable immune deficiency. Curr. Opin. Allergy Clin. Immunol. 12:595–601.
Roifman C.M. and Gelfand E.W. 1988. Replacement therapy with high dose intravenous gamma-globulin improves chronic sinopulmonary disease in patients with hypogammaglobulinemia. Pediatr. Infect. Dis. J. 7:S92–S96.
Stiehm E.R., Casillas A.M., Finkelstein J.Z., Gallagher K.T., Groncy P.M., Kobayashi R.H., Oleske J.M., Roberts R.L., Sandberg E.T., and Wakim M.E. 1998. Slow subcutaneous human intravenous immunoglobulin in the treatment of antibody immunodeficiency: Use of an old method with a new product. J. Allergy Clin. Immunol. 101:848–849.
Wang W., Wang E.Q., and Balthasar J.P. 2008. Monoclonal antibody pharmacokinetics and pharmacodynamics. Clin. Pharmacol. Ther. 84:548–558.
Wasserman R.L., Irani A.M., Tracy J., Tsoukas C., Stark D., Levy R., Chen J., Sorrells S., Roberts R., and Gupta S. 2010. Pharmacokinetics and safety of subcutaneous immune globulin (human), 10% caprylate/chromatography purified in patients with primary immunodeficiency disease. Clin. Exp. Immunol. 161:518–526.
Wasserman R.L., Melamed I., Nelson R.P. Jr., Knutsen A.P., Fasano M.B., Stein M.R., Rojavin M.A., and Church J.A. 2011. Pharmacokinetics of subcutaneous IgPro20 in patients with primary immunodeficiency. Clin. Pharmacokinet. 50:405–414.

Information & Authors

Information

Published In

cover image LymphoSign Journal
LymphoSign Journal
Volume 6Number 2June 2019
Pages: 75 - 86

History

Received: 11 April 2019
Accepted: 16 May 2019
Accepted manuscript online: 22 May 2019

Authors

Affiliations

Canadian Centre for Primary Immunodeficiency, Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON

Metrics & Citations

Metrics

Other Metrics

Citations

Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

There are no citations for this item

View Options

View options

PDF

View PDF

Full Text

View Full Text

Get Access

Login options

Check if you access through your login credentials or your institution to get full access on this article.

Subscribe

Click on the button below to subscribe to LymphoSign Journal

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

Media

Media

Other

Tables

Share Options

Share

Share the article link

Share on social media