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Home IVIG for CIDP: A Focus on Patient Centred Care

Published online by Cambridge University Press:  23 September 2014

Hans D. Katzberg*
Affiliation:
Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario Canada
Vilija Rasutis
Affiliation:
Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario Canada
Vera Bril
Affiliation:
Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario Canada
*
Toronto General Hospital, 200 elizabeth street, 5es-306, Toronto, Ontario, m5G 2C4, Canada. Email: hans.katzberg@utoronto.ca
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Abstract

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Objective:

To determine the safety and tolerability of home-based intravenous immunoglobulin (IVIG) (Gamunex) as maintenance treatment in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in Canada.

Methods:

We enrolled ten subjects with CIDP who had previously received IVIG in the hospital setting to receive the comparable IVIG dose (1-2 g/kg/month) in the home for six months. The patients were evaluated in the clinic at three months and at six months to evaluate their clinical status as well as the safety and tolerability of IVIG.

Results:

All subjects tolerated home-based IVIG treatment as maintenance treatment of CIDP. There were no serious adverse events related to IVIG. Subjects did experience “anticipated” IVIG events post-infusion such as headache and fatigue, which were managed with analgesics and supportive counseling. One subject withdrew consent at end of study due to hospitalization. This event was not related to the IVIG. Another subject experienced a “flare” of CIDP symptoms near the end of the study, however, completed all visits as per protocol. All subjects expressed excellent satisfaction with the individualized therapy, and almost all (nine out of ten) patients preferred home-infusion to hospital-infusion.

Conclusion:

Intravenous immunoglobulin can be delivered safely and is well tolerated outside the hospital setting in Canada in patients with chronic, stable neuromuscular conditions such as CIDP who have previously tolerated IVIG in the hospital medical day Care Unit.

Résumé:

Résumé:Objectif:

Le but de l'étude était de déterminer la sécurité et la tolérabilité de l'administration d'immunoglobuline intraveineuse (IGIV) [Gamunex] comme traitement d'entretien chez des patients atteints de polyradiculoneuropathie démyélinisante inflammatoire chronique (PdIC) au Canada.

Méthode:

Nous avons recruté 10 sujets atteints de PdIC qui avaient reçu de l'IGIV antérieurement en milieu hospitalier afin qu'ils reçoivent une dose comparable d'IGIV (1-2 g/kg/mois) à domicile pendant 6 mois. les patients étaient examinés à la clinique après 3 et 6 mois de traitement pour évaluer leur état clinique ainsi que la sécurité et la tolérabilité de l'IGIV.

Résultats:

Tous les sujets ont bien toléré le traitement à domicile par l'IGIV comme traitement d'entretien de la PdIC. Il n'y a eu aucun incident thérapeutique sérieux relié à l'IGIV. les sujets ont présenté des incidents thérapeutiques concordant avec le profil d'innocuité connu du médicament après l'infusion tels la céphalée et la fatigue qui ont été traités par des analgésiques et un counseling de soutien. Un sujet s'est retiré de l'étude à la fin de celle-ci parce qu'il a dû être hospitalisé. Cet incident n'était pas en lien avec l'IGIV. Un autre sujet a présenté une poussée de symptômes de PdIC vers la fin de l'étude. Il a cependant complété toutes les visites de suivi prévues au protocole. Tous les sujets ont témoigné d'un haut niveau de satisfaction de cette thérapie individualisée et presque tous (9 sur 10 sujets) ont préféré l'infusion à domicile plutôt qu'en milieu hospitalier.

Conclusion:

l'IGIV peut être administrée sans danger en dehors du milieu hospitalier au Canada et ce traitement est bien toléré chez les patients atteints de pathologies neuromusculaires chroniques stables telles la PdIC qui ont bien toléré l'IGIV à l'unité de jour en milieu hospitalier antérieurement.

Type
Research Article
Copyright
Copyright © The Canadian Journal of Neurological 2013

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