IgG Therapy for the Home-Based Patient: Administration and ... - NHIA

IgG Therapy for the Home-Based Patient: Administration 

and Delivery Method Considerations 

By Hetty Lima, R.Ph., FASHP, and Amy Clarke, R.N. 

Adapted from the original April 26 presentation at the 2012 NHIA Annual Conference & Exposition 

Supported by an educational grant from CSL Behring

CE Information: 

Pharmacist 

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education by the state of California, the state of Florida, and the District of Columbia. 

This continuing education article is intended for pharmacists, nurses, dietitians, and other alternatesite infusion professionals. In 

order to receive credit for this program activity, participants must complete the online posttest and subsequent evaluation questions 

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Education, ERS, ANCC Commission on Accreditation, or Commission on Dietetic Registration approval or endorsement 

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Educational Learning Objectives: 

After reading this article, the participant should be able to: 

1. Distinguish between the advantages and disadvantages of SCIG for homebased patients. 

2. Explain the differences in bioavailability and dosing strategy for IVIG versus SCIG. 

3. Describe the role of monitoring outcomes such as disease progression, frequency of infection, and days of school/work 

missed in clinical decision making. 

4. Enumerate the core elements of patient and caregiver education when transitioning a patient to self administration of 

SCIG therapy. 

IgG Therapy for the HomeBased Patient: Administration and Delivery Method Considerations

Author Bios: 

Hetty Lima, R.Ph., FASHP, is the Vice President of Specialty Infusion 

and Rare Diseases at Diplomat Specialty Pharmacy in Flint, 

Michigan. An accomplished health care executive with more 

than 27 years of home infusion/specialty pharmacy experience, 

she has held executive leadership positions at providers such as 

Baxter Healthcare, CVS/Caremark’s Specialty Pharmacy division, 

and Coram’s Hemophilia Services division. A graduate of the University 

of Rhode Island, Lima is also the past President of the 

American Society of HealthSystem Pharmacists’ (ASHP’s) Section 

of Home Care Practitioners. She has lectured at national and 

international pharmacy and nursing meetings and has published 

extensively on the clinical and practical aspects of home infusion 

and specialty pharmacy. Her work has appeared in numerous 

pharmacy and nursing journals and pharmaceutical texts. 

Amy Clarke, R.N., is a registered nurse and has practiced in the 

home infusion arena since 1994, as Director of Nursing for the 

Chicago locations of Chartwell Diversified Services and Option 

Care’s Home Infusion Therapy Pharmacies. Clarke has provided clinical 

education on infusion therapy and specialty medications to 

nursing staff (internal and external), pharmacists, physicians, and 

social workers. She has presented continuing education presentations 

to some of the nation’s top payers including various Blue 

Cross Blue Shield plans, Humana, Aetna and United Healthcare. 

Clarke has a particular passion for immunoglobulin therapy, having 

personally performed over 1,500 IV and SC infusions to date. 

Working with home infusion pharmacy in the 1990s she observed 

that IVIG was not well understood by nursing staff, pharmacies, 

payers, and in many instances the physicians themselves. She has 

developed multiple presentations on IVIG administration 

specifics, as well as the “ins and outs” of subcutaneous IG therapy. 

Clarke has developed a successful national IgG program as 

Program Manager for Diplomat Specialty Pharmacy. 

AUTHOR DISCLOSURE STATEMENT: 

The authors declare no conflicts of interest or financial interest 

in any product or service mentioned in this program, 

including grants, employment, gifts, stock 

holdings, and honoraria. This article may include discussion 

of offlabel/investigational drug use but in a fair and 

unbiased manner. Hetty Lima and her sons use medications 

from the sponsoring organization (CSL Behring) to 

treat Von Willebrand’s Disease. 

IgG Therapy for the HomeBased Patient: Administration and Delivery Method Considerations 1

IgG Market Overview and Uses 

The IgG market has grown steadily over the past several 

years. In 2010, sales of intravenous IgG (IVIG) and subcutaneous 

IgG (SCIG) combined exceeded $2.8 billion. Approximately 

42.3 million grams of product was sold in 2010—an 

8% increase over the previous year. 1 Although IgG is by no 

means a major therapeutic class in terms of payer drug 

spend, like chemotherapy or rheumatology therapies, it is 

gradually becoming a notable category. For a health plan 

with 1 million covered lives, approximately $16 million or 

about 6% of all claims will be for IVIG. 2 

Of the IgG that is used for FDAapproved indications, 36% 

is for the treatment of primary immunodeficiencies, 26% in 

hematology and oncology, 25% for neurological disorders, 

and 13% for miscellaneous indications. 1 However, it’s difficult 

to ascertain the true breakdown of the IgG market because 

a great deal of immune globulin is used for offlabel 

indications. In 2009 the offlabel usages for IVIG represented 

approximately 55% of prescribed product. 1 It’s important 

to note that although these indications are not yet 

approved by the U.S. Food and Drug Administration (FDA), 

many indications are supported by peerreviewed literature 

and are generally accepted for reimbursement by payers. 

See Exhibit 1 for a list of FDAapproved indications and offlabel 

uses. 

With more than 150 specific disease states falling under 

the umbrella of primary deficiency disorders, clinicians and 

payers alike encounter challenges determining when and 

for which patients IgG is most appropriate. A history of 

product shortages and growing demand only serve to increase 

the pressures surrounding these decisions. In 2006, 

the American Academy of Allergy, Asthma, and Immunology 

(AAAAI) conducted a literature review and issued evidencebased 

recommendations for efficient use of IgG, categorizing 

them by the degree to which the therapy was beneficial 

and the strength of the recommendation based on the available 

evidence. 3 This paper and other resources for clinicians 

are available in an online toolkit available at: 

http://www.aaaai.org/practiceresources/managementtoolsandtechnology/ivigtoolkit.aspx. 

The Emergence of SCIG 

The subcutaneous method of IgG (SCIG) administration has 

been an accepted practice in Scandinavia and the United 

Kingdom for some time. Literature dating back 60 years, including 

the research of pioneering American physician 

Ogden Bruton, a pediatrician at Walter Reed Army Hospital, 

documents the safe and effective use of SCIG in a case of 

primary immune deficiency (PID) in an eight year old boy 

with Xlined agammaglobulinemia which is also known as 

“Bruton’s syndrome.” 4 In 1980, Berger and colleagues at the 

National Institutes of Health reported using a portable syringe 

driver to administer IgG to three adult patients, concluding 

that the slow subcutaneous infusions were well 

Exhibit 1 

Uses for IgG 

FDAApproved Indications 

(as of November 2012) 

• Primary immunodeficiencies 

• Allogenic bone marrow/stem cell 

transplant 

• Chronic lymphocytic leukemia 

• Idiopathic thrombocytopenic 

purpura 

• Pediatric HIV 

• Kawasaki disease 

• Chronic inflammatory 

demyelinating polyneuropathy 

(CIDP)* 

• Kidney transplant, with a highantibody 

recipient or an 

ABOincompatible donor 

OffLabel Uses—Neurological 

• GuillainBarre syndrome 

• Multifocal Motor Neuropathy 

• Multiple Sclerosis 

• Myasthenia Gravis (w/exacerbation) 

• Neuromyelitis Optica (Devic’s 

disease) 

• Stiff Person’s syndrome 

OffLabel Uses—Other 

• Dermatomyositis 

• Infertility 

• Pediatric autoimmune 

neuropsychiatric disorders 

associated with Streptococcal 

infections (PANDAS) 

• Pemphigus 

• Polymyositis 

• Renal transplant 

• Scleroderma 

• Sjogren’s syndrome 

• Susac’s syndrome 

* Only GamunexC® and GammaKed® are approved at this time 

Source: Huber, A. Advanced Considerations for Home Administration of Immunoglobulin Therapy. NHIA Annual Conference 

& Exposition, April 2011, Orlando, Florida. 

2 


tolerated and noticeably free of adverse reactions. 5 This 

study paved the way for additional research in both adult 

and pediatric patients—largely with positive results. By 

1981, the safe and effective home administration of SCIG 

was first reported. 6 Subsequent studies reported similar success 

with varying rates of administration. 7,8,9 

Despite these innovations, the subcutaneous (SC) method 

of IgG administration did not take hold in the U.S., largely due 

to the availability of IVIG and the fact that there was no commercial 

product specifically formulated for SC delivery. That 

changed in 2006, when the FDA approved the first IgG formulation 

designed exclusively for subcutaneous administration. 10 

Since then, three additional SCIG formulations have been FDA 

approved for primary immunodeficiency—with others currently 

in clinical trials. The subcutaneous administration of IVIG 

formulations has also become more widespread. 

To date, few studies have been conducted to directly 

compare IVIG and SCIG. However, sufficient available research 

has shown that, due to its relatively stable bioavailability, 

SCIG is associated with fewer systemic adverse 

events. 11 In addition, this administration route offers a variety 

of advantages to patients who are willing to commit 

to selfadministration. 

SCIG Patient Selection 

SCIG offers several advantages over intravenous administration. 

Chief among them is a viable treatment alternative for 

patients with limited vascular access or those who cannot tolerate 

the side effects commonly associated with IV administration. 

The slower administration and gradual absorption of SCIG 

eliminates rapid, large variances in serum IgG levels, which reduces 

adverse affects, such as migraines, and the need to premedicate 

prior to infusion. In addition, consistent serum levels 

achieved through this therapy modality eliminate low trough 

levels, thereby reducing associated symptoms, such as extreme 

fatigue, joint pain, swelling, and malaise. 11 

SCIG also offers greater flexibility and patient autonomy. Although 

the fractionated doses require weekly—or more frequent—infusions, 

patients often enjoy the flexibility of being 

SCIG at a Glance 

Advantages 

• No IV access necessary 

• Fewer systemic side effects, no need to premedicate 

• Fewer systemic effects resulting from peak and 

trough variability 

• Patient flexibility/autonomy 

Disadvantages of SCIG 

• Requires commitment and compliance 

• Not appropriate for large volume therapies or very 

lean patients 

• Requires more frequent infusions 

• Local infusion reactions can occur 


able to perform their own infusions, at home when it’s convenient, 

without having to travel to and from a treatment center. 

A 2010 study showed that patients preferred SCIG over IVIG 

therapy (92%) and home therapy over therapy at the 

clinic/physician (83%). 12 

Unfortunately, patients requiring higher IgG doses, such as 

those with autoimmune diseases, may not be appropriate 

candidates for SCIG therapy due to the large volume of fluid 

that would need to be delivered. This is especially true for patients 

on formulations with comparatively lowerconcentration 

IgG (i.e. 10% vs 16% or 20%). Similarly, patients who are 

very lean may not be suitable candidates for SCIG because 

they often have limited appropriate sites for SC access. 

For SCIG to be successful, patients and caregivers must 

be committed to learning and adapting to selfcare. They 

should also have a demonstrated history of therapy compliance. 

Independence is typically achieved after two to four 

nurse teaching visits with continued clinical monitoring and 

patient followup. 

Dosing and Conversion to SCIG 

Several studies demonstrate favorable improvement in infection 

rates, hospital admissions, and overall morbidity for patients 

on SCIG. 7,1316 But, how much IgG is needed to achieve 

these results, and what is the best dosing strategy for patients 

just starting SCIG therapy and/or converting from IVIG? 

Not all patients respond the same way to the many IgG formulations 

on the market. Differences in pH, osmolarity, 

amount of sucrose, and amount of IgA, make product selection 

very individualized. Similarly, there is no cookie cutter 

formula for dosing—although higher doses are beginning to 

be supported in the literature as offering improved clinical 

benefits and quality of life for patients. 17 

Unlike IVIG, SCIG doesn’t immediately enter the circulatory 

system during administration. For this reason, it has a 

lower systemic bioavailability and more stable serum levels 

following administration. Weekly administration of SCIG 

leads to stable steadystate serum IgG levels with lower 

peak levels and higher trough levels compared to monthly 

IVIG treatment (see Exhibit 2). The FDA recognized this difference 

and adjusted dosing to achieve a similar “area under 

the curve” (AUC) by using a productspecific multiplier for 

calculating dosages. Formulas for converting IVIG doses are 

provided in package inserts and available from IgG manufacturers 

online (see Exhibit 3). 

The optimal dose of IgG for primary immune deficiency was 

considered to be 400800 mg/kg/month (100200 

mg/kg/week for SCIG) with the goal of achieving serum levels 

of 500 mg/dL or greater. 18,19 But, in 2006, the PID Committee 

of the AAAAI issued a report in which it asserted that the 

dose of IgG should be titrated to achieve a trough level 

greater than 500 mg/dL in agammaglobulinemic patients and 

that trough levels greater than 800 mg/dL have the potential 

to improve pulmonary outcomes. 3 This was further demonstrated 

in a 2010 metaanalysis of PIDD patients on IVIG therapy 

and experiencing pneumonia, whose rates of infection 

were reduced by increasing the IgG trough levels to midnormal 

range (1,000 mg/dL). 17 A subsequent study, published in 

2012, examined a broader set of outcomes and also favored 

higher doses of IgG. Researchers comparing results from two 

parallel clinical studies found that PIDD patients who maintained 

a higher mean IgG dose (1.5 times higher) had significantly 

lower rates of nonserious infections, hospitalization, 

antibiotic use, and missed work/school activity. In addition, 

the higherdose group experienced lower health care utiliza 

Exhibit 2 

Subcutaneous Versus Intravenous 

Serum Ig levels 

Total IgG 

1600 

1400 

1200 

1000 

800 

600 

400 

Intravenous Ig 

Subcutanenous Ig 

0 2 4 6 8 10 12 14 16 18 20 22 

Days 

Source: P&T Product Profiler – Hizentra Vol. 35, Issue 8 / 

August 2010 Section 2 / adapted from Berger 2004. Available 

at http://www.ptcommunity.com/ptjournal/fulltext/Profiler_Hizentra/Profiler_Hizentra.pdf 

Exhibit 3 

FDA-Recommended Dose Conversion 

for SCIG 

• 20% products = IVIG dose (g) x 1.53 / number of 

weeks between doses 

• 10% products = IVIG dose (g) x 1.37 / number of 

weeks between doses 

4 


tion and improved indices of wellbeing compared to the 

group treated with traditional IgG doses. 18 

Many clinicians now believe that the mean dose adjustment 

coefficient and the mean trough level ratio should only 

be used as rough guides in dosing. As additional outcomes, 

such as slowing of disease progression, frequency of infection, 

days of work/school missed, etc., are considered, experienced 

clinicians are tending toward higher doses while 

relying on patient monitoring to adjust therapeutic levels of 

IgG. In a survey of immunologists, those with more indepth 

experience—more than 10% of their practice was devoted 

to PID patients—were significantly more likely to target 

higher serum levels (above 750 mg/dL); whereas those with 

fewer than 10% PID patients usually targeted lower serum 

levels (500750 mg/dL). 20 

Home infusion and specialty pharmacy providers can play a 

critical role in patient monitoring by collecting supporting documentation 

on the therapeutic effectiveness of IgG regimens 

from a variety of perspectives, including: response to therapy, 

abatement of symptoms, and quality of life. This data provides 

meaningful feedback for physicians working to find each patient’s 

dosing “sweet spot,” and also aids in building a case for 

reimbursement, especially if the patient’s recommended 

dosage falls outside the “normal” payer guidelines. 

SCIG Administration 

SCIG administration presents some unique challenges from 

a clinical perspective. With the medication itself, volume and 

viscosity are key factors in care planning. The therapy also 

involves a different—but similar—set of supplies than those 

used to administer IVIG. 

For example, the home infusion/specialty pharmacy care 

team should map out a regimen based on the prescribed dosing 

parameters. They need to consider the individual patient 

and total volume of therapy to determine the number of fractionations 

and sites to be infused with each administration. 

As a rule of thumb, infusions should last 4550 minutes, and 

should not be longer than 90 minutes. Generally, no more 

than 15 mL should be administered in any one site. In order 

to limit swelling, a rate of 20 mL/hour is suggested for rapid 

infusions; 4 mL/hour is suggested for longer infusions. 11 

SCIG is viscous—much more so than the sterile water used 

to calibrate typical IV administration rates—so tubing sets 

need to be adjusted to achieve the desired rate. For example, 

pumps and tubing may need to be set at 600 mL/hr to deliver 

20 mL/hr to the patient. There are several infusion pumps 

and needles specifically designed for SC administration— 

some pumps use only proprietary sets. Many pump manufacturers 

offer sample supply lists online to prompt pharmacy 


Hot packs, which cause vasodilatation, can trigger a similar 

reaction, and should be avoided. However, cold is an effective 

tool in preventing site reactions and slightly numbing 

the area prior to needle insertion. Many providers advise 

patients to use freezer packs or even place flat rocks in the 

freezer for chilling an injection site prior to administration. 

Topical steroids and histamine blockers are also effective in 

reducing minor site reactions. 

Regardless of the route of administration, IgG therapy 

is the inoculation of a proteinbased substance into the 

body. Therefore, adverse reactions similar to those reported 

with other IgG administration methods may also 

occur. While the most frequent adverse reaction is a 

local reaction at the injection site, Exhibit 4 lists other 

adverse reactions reported in clinical studies as a percentage 

of subcutaneous administrations for one formulation 

of SCIG. 21 

Preparing the Patient for SCIG Therapy 

As mentioned previously, patients who take on selfadministration 

must be willing to undergo appropriate training. 

Patients and caregivers are taught administration techniques 

via handson instruction from a nurse, and asked to 

return demonstrate successfully before independently performing 

selfinfusion. 

Exhibit 4 

Adverse Reactions for SCIG 

ordering. It should also be noted that a growing number of 

prescribers prefer IV push administration, which is lowertech 

but also reduces supply costs. 

While rotating injection sites is a standard best practice for 

most therapies, this is not the case for SCIG. After a few administrations, 

subcutaneous pockets can accept the IgG more 

readily without triggering an antibody reaction. Most SCIG 

patients use the same sites repeatedly, or alternate every 

other use. It’s also important to note that inadvertent intradermal 

injection of IgG could cause the release of mediators 

resulting in an adverse reaction via complement activation. 11 

The best way to avoid this is to be sure that the needle length 

is appropriate for the individual patient and injection site. 

Adverse Reaction 

(n=3,656 infusions) 

Injection site reactions 49% 

Noninjection site reactions 

• Headache 1.6% 

• Rash 0.2% 

• Nausea 0.2% 

• Nervousness 0.1% 

• Asthenia 0.1% 

• Skin disorder 0.1% 

• Urine abnormality 0.1% 

• Fever 0.1% 

• Dyspnea 0.1% 

• Gastrointestinal pain 0.1% 

• Tachycardia 0.1% 

Frequency 

Source: ZLB Behring. Immune Globulin Subcutaneous 

(Human) Vivaglobin Prescribing information, January 

2006. 

6 


The primary driver in the success of that educational effort is 

being sure that the patient knows what to expect. The home 

infusion care team should create a care plan that details the 

number of infusions per week/month the patient will have, an 

estimated time for each infusion, the volume being infused, and 

the number of sites accessed. This information—along with a 

set of supplies, written instructions, and pharmacy contact information—should 

be supplied prior to the teaching visit. 

Typically, patients and/or caregivers can become independent 

in as few as two or three teaching visits (see Exhibit 

5). During the first visit, the nurse performs the entire administration, 

explaining each step as the patient observes. 

There should be time for the patient to ask questions and 

get acquainted with the many various supplies. The second 

visit is a tandem administration with the patient performing 

the majority of the tasks with verbal cues from the nurse. 

The nurse may perform certain tasks, such as the needlestick. 

By the third visit, the patient should be able to perform 

all of the tasks with only minimal cuing from the nurse. If 

the patient or caregiver is not fully independent, more visits 

may be offered. Additional support, such as phone assistance 

and access to manufacturer teaching materials, may 

also be offered. 

Another critical element for success is regular followup. 

Phone calls to check on patient progress and answer questions 

aid in compliance and help patients avoid complications 

that can sometimes arise from lapses in technique. 

Patients should be made aware of what to expect during 

SCIG administration. Typically, the first several infusions result 

in a stretching, burning, tingling feeling at the injection site. 

This sensation usually disappears after the tissue in and around 

subcutaneous space becomes sensitized. Patients may continue 

to experience sunburnlike redness and swelling at the 

injection site and a “goose egg” reservoir of fluid in the subcutaneous 

space, due to the volume of infusion. These fluid pockets 

generally disappear within 6 24 hours as the fluid is 

absorbed into the body. It’s common for patients to feel tenderness 

and/or discomfort at the infusion site 12 24 hours following 

administration; counsel them to choose activities and 

even clothing appropriately. Patients may also experience 

bruising 5 10 days after an infusion, and should know not to 

be alarmed by the delayed appearance of bruising. 

Exhibit 5 

Core Elements of Patient Education 

• Therapy regimen. The patient’s lifestyle must accommodate more frequent (weekly vs. monthly) administrations. 

Patients must also understand that compliance with an independent self administration schedule is essential to 

good outcomes. 

• Anaphylaxis procedures. Review epinephrine autoinjector use and storage procedures in the event of an anaphylactic 

reaction. 

• Hand hygiene. Proper hand hygiene is a core element in all effective infection control programs, including in the patient’s 

home. 

• Site selection and preparation. Patients should be involved in determining which site(s) to use for infusion based 

on comfort, body mass, convenience, etc. They should also be counseled on how to recognize improper needle 

length for the site used (i.e. A needle that is too long may brush muscle wall causing bruising and discomfort, or a 

needle that is too short can infuse intradermally, increasing the severity of local infusion site reactions.) 

• Supplies. Patients should receive a list with all the supplies needed for their care along with storage/handling instructions. 

Inventory awareness and appropriateness should also be stressed with patients during the training 

phase, as they will be expected to assist their pharmacy with their supply needs and should know how to communicate 

supply and usage needs. 

• Priming needles. Patients should be instructed that all effort should be taken to insert a dry needle so that IgG is 

not being tracked through the dermis, triggering a possible histamine release and increasing the probability of a 

local site reaction. 

• Needlestick procedure. Teach patients to insert the needle into the subcutaneous space and how to avoid intradermal 

injection. Proper placement of the needles limits leaking, discomfort, and localized site reactions. Also teach 

90degree angle insertion, avoiding scars, skin folds, or keloids. 

• Needle Securement: Apply tape over the needle in a chevron pattern to hold it securely in place during the infusion, 

minimizing the risk of dislodgement and subsequent intradermal infusion. 

• Disposal of trash and medical waste. Instruct patients on state and local regulations and to have appropriate 

garbage receptacle ready before the administration procedure begins. 

• Adverse reactions. While local site reactions are the most common, patients should also be educated regarding the 

rare risks of aseptic meningitis, renal compromise, and cardiac compromise – particularly if there is comorbidity. 

• Troubleshooting. Caution patients that the use of heating pads may increase a histamine response. Icing with a 

cold water bottle before needle placement minimizes pain and can enhance comfort. Chronic leaking or redness at 

the site should be a sign for the patient to discuss the needle length and/or pretreatment with their clinician. 


It’s important that patients are educated about the 

types of adverse reactions associated with SCIG and how 

to recognize them. Symptoms, such as warmth, redness, 

and itching may be associated with a lessserious site reaction 

and may be resolved by working with their clinical 

team to strategize a pretreatment plan or reexamine 

needle length, administration procedure, or other variables. 

See the “SCIG Administration” section on page 5 

for more information. 

Case Study 

Converting IVIG patient to SCIG 

Mr. D was a 46yearold male with CIPD. He 

was experiencing pain and decreased 

strength in his lower extremities. For four 

years, he had been receiving the same IVIG 

formulation (offlabel) at an infusion center. 

To be treated, he needed to travel 60 minutes 

(each way) monthly, in addition to wait 

and infusion time at the hospitalbased infusion 

clinic. 

Following his infusions, he experienced 

severe chronic reactions, including migraine, 

vomiting, and flulike symptoms 

and was bedridden for up to three days 

postinfusion. Overall, his disease state 

was poorly controlled and his quality of life 

was greatly diminished. 

The specialty infusion team worked with 

Mr. D’s physician to find an alternative IVIG 

formulation that might reduce the side effects 

Actual patient not shown. Photo courtesy of Melvin Berger, M.D. and CSL Behring 

he was experiencing. The team educated the 

physician on recognizing patientspecific product 

intolerances as well as raterelated side effects 

that can be abated by using a standard IVIG infusion rate (which the center was not doing). 

Mr. D successfully switched to a different IVIG product without incident and received his infusions at home. His infusion 

reactions resolved—he was no longer bedbound for three days with flulike symptoms each month—and his trips to the 

infusion center were also eliminated which conservatively saved his payer $20,000 per year in infusion suite costs. Mr. D 

also reported decreased pain in his limbs and neck. 

Mr. D then expressed his desire to move to SCIG in order to become even more autonomous. He converted successfully 

after three nurseteaching visits, and reports having improved energy levels and quality of life. He has regular monthly 

assessments with his physician, and the specialty pharmacy infusion team follows his progress. 

Subcutaneous immune globulin therapy offers a safe, less invasive alternative to intravenous IG therapy to those patients 

and caregivers willing to selfadminister in the home setting. 

8 


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National Home Infusion Association • 703.549.3740 • www.nhia.org • info@nhia.org

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