Some patients prefer subcutaneous administration of IgG several times per week instead of weekly

If the time, number of sites, or volume per site in the planned regimen seems excessive, splitting the dose into two or more infusions per week should be considered.

In many cases, the patient's tolerance of local site reactions increases with repeated infusions, and the time for each infusion can be shortened or the volume of IgG infused per site can be increased.


Hizentra is 20% immunoglobulin for subcutaneous therapy (SCIG) of immunodeficiency.

Each of the parameters in table 1 (shown below) may be considered independently, and varied to reach a regimen that fits easily into each patient's preferences.

Some investigators have explored options at the extremes of the above regimens.

For example, Shapiro in Minnesota and Ochs in Seattle have reported anecdotally that many patients prefer to increase the parameter of the number of infusions per month out to 20 to 30, by giving “daily pushes” of 10 mL each, which is done conveniently by repeatedly pushing 1 to 2 mL from a 10-mL syringe without any mechanical pump at all. Daily doses of 10 mL (1.6 g, if a 16% IgG solution is used) are easily given over 5 to 10 minutes in this way, and are well tolerated by many patients. Infusing 1.6 g every weekday gives a monthly dose of 35.2 g, and the patient does not have to take infusions on the weekends. In contrast, if the patient takes a 1.6-g infusion every day, the total monthly dose will be 48.8 g per month.

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Table 1:

Establishing an optimal subcutaneous immunoglobulin regimen for any individual patient

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1. Predetermination: dose of IgG in mg/kg/mo. Start with estimated dose of 500 mg/kg/mo, use current monthly IV dose, or use current monthly IV dose × correction for bioavailability if desired.

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2. Parameters that should be selected in accordance with patients preferences:

Number of infusions per week or month
Volume per infusion
Number of sites per infusion
Volume per site
Total time for each infusion
Decision to use multiple sites simultaneously or sequentially
Number of pumps

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References:

Subcutaneous administration of IgG. Berger M. Immunol Allergy Clin North Am. 2008 Nov;28(4):779-802, viii.

HyQvia combines IgG Infusion 10% and hyaluronidase, packaged as a kit for treatment of primary immunodeficiency. Baxter, 2012.