Immunoglobulin therapy during the last 20 years and its effect on infections in common variable immunodeficiency (CVID)

Common variable immunodeficiency disorders (CVIDs) are the most common forms of symptomatic primary antibody failure in adults and children. The most common immunodeficiency is a IgA deficiency. Replacement immunoglobulin is the standard treatment for CVID, although there are few studies on optimal dosages and target trough IgG levels required for infection prevention.

Data, collected prospectively from a cohort of 90 patients with CVIDs from 1 center over a follow-up period of 22 years, was analyzed. A smaller group of patients with X-linked agammaglobulinemia was analyzed for comparison.

Patients with a CVID had a range of trough IgG levels that prevented breakthrough bacterial infections (5-17 g/L); viral and fungal infections were rare.

Doses of replacement immunoglobulin to prevent breakthrough infections ranged from 0.2 to 1.2 g/kg/mo. Those with proven bronchiectasis or particular clinical phenotypes required higher replacement doses.

Patients with X-linked agammaglobulinemia showed a similar range of IgG levels to stay infection-free (8-13 g/L).

The authors concluded that the goal of replacement therapy should be to improve clinical outcome and not to reach a particular IgG trough level.

Since 1990s, no transmission of infectious diseases have been reported from U.S.-licensed IVIG products.

Infection outcomes in patients with common variable immunodeficiency disorders: Relationship to immunoglobulin therapy over 22 years. Lucas M, Lee M, Lortan J, Lopez-Granados E, Misbah S, Chapel H. J Allergy Clin Immunol. 2010 May 12.
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