Subcutaneous immunoglobulin in chronic inflammatory demyelinating polyneuropathy - neurologist, nursing and patient perspectives

Immunoglobulin (Ig) therapy is a common treatment for chronic inflammatory demyelinating polyneuropathy (CIDP). Intravenous immunoglobulins (IVIg) have been shown to be efficacious in CIDP; however, many patients experience fluctuations in functionality throughout the treatment cycle, systemic adverse events (AEs) and inconvenience due to hospital-based treatment. An alternative to IVIg is subcutaneous immunoglobulin (SCIg). Several studies have demonstrated the efficacy of SCIg in CIDP, with the recent PATH study leading to the approval of the 20% SCIg IgPro20 (Hizentra®) by agencies including the US Food and Drug Administration, Health Canada and the European Medicine Agency. SCIg administration differs from IVIg and therefore requires patients and nurses to be adequately trained in self-administration techniques and treatment monitoring. SCIg can be administered via a manual push method or using a pump. Training patients to self-administer is straightforward; however, current efficacy monitoring assessments could be improved to better suit home-based therapy. Preference for SCIg is often due to increased autonomy, reduced systemic AEs and reduced fluctuations in functionality; but ultimately, the preference for SCIg or IVIg will often depend upon a patient's individual personality and lifestyle.