Optimizing immunoglobulin treatment for patients with primary immunodeficiency disease to prevent pneumonia and infection incidence: Review of the current data

Background An increasing body of evidence suggests that the optimal dose for IgG replacement therapy is the dose that keeps the patient as free from infection as possible by either intravenous or subcutaneous delivery. Objective To review the current evidence on optimizing IgG therapy in patients with primary immunodeficiency disease (PIDD). Methods Surveys conducted among physicians who treat patients with PIDD indicate that most practitioners follow existing data and guidelines on the use and dosage of immunoglobulin therapy. On the basis of the current guidelines, most use intravenous immunoglobulin (IVIG) therapy at a starting dose of 400 mg/kg every 4 weeks to treat a number of primary PIDDs with humoral immune deficiencies. However, for the optimal treatment of PIDDs, therapy needs to be tailored. Results Among the issues is the assessment of IgG trough levels or steady-state levels with subcutaneous immunoglobulin (SCIG) therapy needed to reduce or prevent infection in patients with PIDD. Increasing evidence suggests that optimization of treatment can be based on identifying the dosage of IVIG or SCIG for each patient needed to reduce infection. Conclusion More studies are needed to better clarify the optimal dose, IgG trough level, or IgG steady-state level necessary to reduce infection and optimize treatment for patients with PIDD treated with IVIG or SCIG.