Abstract
Humoral immunodeficiency diseases represent a heterogeneous group of disorders that require long-term therapies. Thus, the treatment provided must not only be effective but also safe and well tolerated. In this paper, we report our data on the efficacy, safety, and tolerability of recombinant human hyaluronidase-facilitated subcutaneous infusion of immunoglobulin (Ig) (fSCIG; HyQvia(®)) in immunodeficiency patients. We collected retrospective data from 30 patients with primary and secondary immunodeficiency diseases in therapy with fSCIG from September 2014 to December 2019. We evaluated the efficacy of the therapy, taking into account serum IgG values during follow-up and the number of annual infectious events and serious bacterial infections reported by patients. Safety was assessed on the basis of the number and intensity of adverse events (AEs) and local reactions reported. Our real-life data suggest that long-term repeated self-administration of recombinant human hyaluronidase-facilitated subcutaneous infusion of immunoglobulins results in a reduced rate of infectious events if compared to the pre-treatment rate. Both AEs and local reactions are mild to moderate and were never reasons for treatment discontinuation. Therapy with HyQvia shows prolonged efficacy and good tolerability; these aspects, together with the possibility of self-administration at home, minimize the impact the illness has on patients.
Similar content being viewed by others
References
Bonilla FA, Khan DA, Ballas ZK, et al. Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma & Immunology; and the Joint Council of Allergy, Asthma & Immunology. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin. Immunol. 2015;136:1186–205. https://doi.org/10.1016/j.jaci.2015.04.049.
Picard C, Al-Herz W, Bousfiha A, et al. Primary immunodeficiency diseases: an update on the classification from the international union of immunological societies expert committee for primary immunodeficiency 2015. J Clin Immunol. 2015;35:696–726. https://doi.org/10.1007/s10875-015-0201-1.
Artac H, Kara R, Reisli I. In vivo modulation of the expressions of Fas and CD25 by intravenous immunoglobulin in common variable immunodeficiency. Clin Exp Med. 2010;10(1):27–31.
Di Renzo M, Pasqui AL, Auteri A. Common variable immunodeficiency: a review. Clin Exp Med. 2004;3(4):211–7.
Berger M. Principles of and advances in immunoglobulin replacement therapy for primary immunodeficiency. Immunol Allergy Clin N Am. 2008;28:413–37. https://doi.org/10.1016/j.iac.2008.01.008.
Desai SH, Chouksey A, Poll J, Berger M. A pilot study of equal doses of 10% IGIV given intravenously or subcutaneously. J Allergy Clin Immunol. 2009;124:854–6. https://doi.org/10.1016/j.jaci.2009.07.051.
Gur-Cetinkaya P, Cagdas-Ayvaz DN, Oksuz AB, et al. Advantage of the subcutaneous immunoglobulin replacement therapy in primary immunodeficient patients with or without secondary protein loss. Turk J Pediatr. 2018;60:270–6. https://doi.org/10.24953/turkjped.2018.03.006.
Chapel HM, Spickett GP, Ericson D, Engl W, Eibl MM, Bjorkander J. The comparison of the efficacy and safety of intravenous versus subcutaneous immunoglobulin replacement therapy. J Clin Immunol. 2000;20:94–100.
Ochs HD, Gupta S, Kiessling P, Nicolay U, Berger M. Safety and efficacy of self-administered subcutaneous immunoglobulin in patients with primary immunodeficiency diseases. J Clin Imunol. 2006;26:265–73. https://doi.org/10.1007/s10875-006-9021-7.
Jolles S, Bernatowska E, de Gracia J, et al. Efficacy and safety of Hizentra® in patients with primary immunodeficiency after a dose-equivalent switch from intravenous or subcutaneous replacement therapy. Clin Immunol. 2011;141:90–102. https://doi.org/10.1016/j.clim.2011.06.002.
Jolles S, Rojavin MA, Lawo JP, et al. Long-term efficacy and safety of Hizentra® in patients with primary immunodeficiency in Japan, Europe, and the United States: a review of 7 Phase 3 TrialsJ. J Clin Immunol. 2018;38:864–75. https://doi.org/10.1007/s10875-018-0560-5.
Berger M, Rojavin M, Kiessling P, Zenker O. Pharmacokinetics of subcutaneous immunoglobulin and their use in dosing of replacement therapy in patients with primary immunodeficiencies. Clin Immunol. 2011;139:133–41. https://doi.org/10.1016/j.clim.2011.01.006.
Kobrynsky L. Subcutaneous immunoglobulin therapy: a new option for patients with primary immunodeficiency diseases. Biologics. 2012;6:277–87. https://doi.org/10.2147/BTT.S25188.
Jolles S, Borte M, Nelson RP, et al. Long-term efficacy, safety, and tolerability of Hizentra® for treatment of primary immunodeficiency disease. Clin Immunol. 2014;150:161–9. https://doi.org/10.1016/j.clim.2013.10.008.
Rojavin MA, Hubsch A, Lawo JP. Quantitative evidence of wear-off effect at the end of the intravenous IgG (IVIG) dosing cycle in primary immunodeficiency. J Clin Immunol. 2016;36:210–9. https://doi.org/10.1007/s10875-016-0243-z.
Berger M. Subcutaneous immunoglobulin replacement in primary immunodeficiencies. Clin Immunol. 2004;112:1–7. https://doi.org/10.1016/j.clim.2004.02.002.
Wasserman RL, Melamed I, Nelson RP, et al. Pharmacokinetics of subcutaneous IgPro20 in patients with primary immunodeficiency. Clin Pharmacokinet. 2011;50:405–14. https://doi.org/10.2165/11587030-000000000-00000.
NIH Consensus Conference. Intravenous immunoglobulin. Prevention and treatment of disease. JAMA. 1990;264:3189–93.
Vacca A, Melaccio A, Sportelli A, Solimando AG, Dammacco F, Ria R. Subcutaneous immunoglobulins in patients with multiple myeloma and secondary hypogammaglobulinemia: a randomized trial. Clin Immunol. 2018;191:110–5. https://doi.org/10.1016/j.clim.2017.11.014.
Compagno N, Malipiero G, Cinetto F, Agostini C. Immunoglobulin replacement therapy in secondary hypogammaglobulinemia. Front Immunol. 2014;5:626. https://doi.org/10.3389/fimmu.2014.00626.
Gardulf A, Nicolay U, Math D, et al. Children and adults with primary antibody deficiencies gain quality of life by subcutaneous IgG self-infusions at home. J Allergy Clin Immunol. 2004;114:936–42. https://doi.org/10.1016/j.jaci.2004.06.053.
Gür-Çetinkaya P, Çağdaş-Ayvaz DN, Öksüz AB, et al. Advantage of the subcutaneous immunoglobulin replacement therapy in primary immunodeficient patients with or without secondary protein loss. Turk J Pediatr. 2018;60(3):270–6. https://doi.org/10.24953/turkjped.2018.03.006.
Högy B, Keinecke HO, Borte M. Pharmacoeconomic evaluation of immunoglobulin treatment in patients with antibody deficiencies from the perspective of the German statutory health insurance. Eur J Health Econ. 2005;6:24–9.
Wasserman RL, Melamed I, Stein MR, et al. Recombinant human hyaluronidase-facilitated subcutaneous infusion of human immunoglobulins for primary immunodeficiency. J Allergy Clin Immunol. 2012;130(951–7):e11. https://doi.org/10.1016/j.jaci.2012.06.021.
Frost GI. Recombinant human hyaluronidase (rHuPH20): an enabling platform for subcutaneous drug and fluid administration. Expert Opin Drug Deliv. 2007;4:427–40.
Thomas JR, Yocum RC, Haller MF, von Gunten CF. Assessing the role of human recombinant hyaluronidase in gravity-driven subcutaneous hydration: the INFUSE-LR Study. J Palliat Med. 2007;10:1312–20. https://doi.org/10.1089/jpm.2007.0126.
Allen CH, Etzwiler LS, Miller MK, et al. Recombinant human hyaluronidase-enabled subcutaneous pediatric rehydration. Pediatrics. 2009;124:e858–67. https://doi.org/10.1542/peds.2008-3588.
Harb G, Lebel F, Battikha J, Thackara JW. Safety and pharmacokinetics of subcutaneous ceftriaxone administered with or without recombinant human hyaluronidase (rHuPH20) versus intravenous ceftriaxone administration in adult volunteers. Curr Med Res Opin. 2010;26:279–88. https://doi.org/10.1185/03007990903432900.
Suez D, Stein M, Gupta S, et al. Efficacy, safety and pharmacokinetics of a novel human immune globulin subcutaneous, 20% in patients with primary immunodeficiency diseases in North America. J Clin Immunol. 2016;36:700–1226.
US Food and Drug Administration. US, Department of Health and Human Services, Guidance for Industry: Safety, Efficacy, and Pharmacokinetic Studies to Support Marketing of Immune Globulin Intravenous (Human) as Replacement Therapy for Primary Humoral Immunodeficiency, 2008. https://doi.org/10.1007/s10875-016-0327-9.
Canessa C, Iacopelli J, Pecoraro A, et al. Shift from intravenous or 16% subcutaneous replacement therapy to 20% subcutaneous immunoglobulin in patients with primary antibody deficiencies. Int J Immunopathol Pharmacol. 2017;30(1):73–82. https://doi.org/10.1177/0394632016681577.
Atkinson MJ, Sinha A, Hass SL, Colman SS, Kumar RN, Brod M, Rowland CR. Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease. Health Qual Life Outcomes. 2004;2:12.
Kainulainen L, Vuorinen T, Rantakokko-Jalava K, et al. Recurrent and persistent respiratory tract viral infections in patients with primary hypogammaglobulinemia. J Allergy Clin Immunol. 2010;126(1):120–6. https://doi.org/10.1016/j.jaci.2010.04.016.
Rosengren S, Dychter SS, Printz MA, et al. Clinical Immunogenicity of rHuPH20, a hyaluronidase enabling subcutaneous drug administration. AAPS J. 2015;17(5):1144–56. https://doi.org/10.1208/s12248-015-9782-0.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Ethical approval
The study was notified to the Ethics Committee of Area Vasta Nord Ovest (Pisa, Italy); due to the observational, retrospective nature of the study, formal approval was not required.
Informed consent
Informed consent was not required because the data were collected anonymously.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Angelotti, F., Capecchi, R., Giannini, D. et al. Long-term efficacy, safety, and tolerability of recombinant human hyaluronidase-facilitated subcutaneous infusion of immunoglobulin (Ig) (fSCIG; HyQvia(®)) in immunodeficiency diseases: real-life data from a monocentric experience. Clin Exp Med 20, 387–392 (2020). https://doi.org/10.1007/s10238-020-00633-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10238-020-00633-4