Patient-reported outcomes with subcutaneous immunoglobulin in secondary immunodeficiency

Juthaporn Cowan ^1,2,3* Il-Kang Na ^4,5,6,7 André Gladiator ⁸ Marta Kamieniak ⁹ Shahzad Mustafa ^10,11

• ¹ Department of Medicine, Division of Infectious Diseases, University of Ottawa, Ontario, Canada
• ² Department of Biochemistry, Microbiology and Immunology, and Centre for Infection, Immunity and Inflammation, University of Ottawa, Ontario, Canada
• ³ Inflammation and Chronic Disease Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
• ⁴ Dept of Hematology, Oncology and Tumor Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐ Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
• ⁵ Experimental and Clinical Research Center, Berlin, Germany
• ⁶ Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
• ⁷ German Consortium for Translational Cancer Research, (DKTK), Partner site Berlin, Charité, Universitätsmedizin, Berlin, Germany
• ⁸ Takeda Pharmaceuticals International AG, Zurich, Switzerland
• ⁹ Takeda Development Center Americas, Inc., Cambridge, MA, United States
• ¹⁰ Division of Allergy, Immunology, and Rheumatology, Rochester Regional Health, Rochester, New York, New York, United States
• ¹¹ Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States

Subcutaneous (SCIG) and intravenous immunoglobulin (IVIG) replacement are both used to prevent infections in patients with secondary immunodeficiency (SID). Compared with IVIG, SCIG has fewer systemic side effects and, additionally, facilitates home-based treatment. Shared decision-making practice should include discussion of aspects such as patient preference as well as the associated risks and benefits of treatment. We review the available evidence for the use of SCIG treatment in patients with SID, focusing on patient-reported outcomes (PROs). In most studies, there were improvements to health-related quality of life with SCIG treatment, compared with before initiating SCIG without prior IVIG treatment, or after switching to SCIG from IVIG treatment, or a no-SCIG/IVIG cohort. Treatment satisfaction with SCIG was similar between patients with SID and primary immunodeficiency disease. Patient preference and perception assessments highlighted the benefits of SCIG compared with IVIG, such as ease of use and administration, convenience, and time-effectiveness. In addition, many patients self-administered SCIG at home. Such aspects may be of specific benefit to patients with SID and hematological malignancy by reducing the risk of infection exposure in clinical settings. PRO data may be useful during shared decision-making discussions with patients with SID.