Impact of IVIG vs. SCIG on IgG trough level and infection incidence in primary immunodeficiency diseases: A systematic review and meta-analysis of clinical studies

摘要

Background:Monthly intravenous immunoglobulin (IVIG) and weekly subcutaneous immunoglobulin (SCIG) have been regarded as therapeutically equivalent treatments for primary immunodeficiency diseases (PIDD). Immunoglobulin G (IgG) trough level is used as a monitoring measure for infection prevention.Objective:A systematic review and meta-analysis were performed to elucidate the relationship between IgG dosing, trough IgG levels with overall infection incidence in patients with PIDD receiving IVIG and SCIG therapy.Methods:Medline, EMBASE, Cochrane, Central, and Scopus were searched for studies published from Jan 2010-June 2018, fulfilling the inclusion criteria. DerSimonian and Laird random-effects method were used to pool the difference of IgG trough levels. Random-effect meta-regression was used to evaluate infection incidence per 100?mg/dl IgG trough increase though IVIG and SCIG.Results:Out of 24 observational studies included, 11 compared IgG trough levels among SCIG and IVIG (mean difference: 73.4?mg/dl, 95% CI: 31.67-119.19?mg/dl, I2?=?45%, p?=?0.05), favoring weekly SCIG. For every 100?mg/dl increase in the trough, a linear trend of decreased incidence rates of infection was identified in SCIG patients (p?=?0.03), but no similar trend was identified in trough levels vs. infection rates for patients receiving IVIG (p?=?0.67).Conclusion:In our study, weekly SCIG attained a higher trough level in comparison to monthly IVIG. Higher SCIG troughs were associated with lower infection rates, while IVIG troughs demonstrated no relationship.? 2019 The Authors.