Subcutaneous Immunoglobulin for CIDP
Subcutaneous Immunoglobulin for CIDP
The investigators are using self administered subcutaneous IG in patients with CIDP who
 require IVIG. Safety, efficacy, and patient satisfaction will be examined.
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune neurological
 disorder that causes limb weakness and numbness. Many patients require immunosuppressants and
 plasma exchange (PLEX) to control their symptoms. Intravenous immunoglobulin (IVIG)is also an
 effective treatment (Hughes et al, 2006 & 2008; Hughes, 2009; Cocito et al, 2010), and the
 American Academy of Neurology (AAN) guideline recommended that it should be offered in the
 long-term treatment of CIDP (Patwa et al, 2012). While effective, IVIG causes systemic side
 effects in about 5% of patients. These side effects include rash, pruritus, myalgia, fever,
 chills, headache, low back pain, nausea, vomiting, changes in blood pressure or heart rate,
 renal failure, and aseptic meningitis (Berger, 2008). For many patients who are chronically
 treated with IVIG, venous access may be a problem over time. An alternative is the
 subcutaneous (SC) route, which has been in use since 1980 for primary immune deficiency
 disorders and is the treatment of choice for this condition in Scandinavia and England
 (Radinsky et al, 2003). As compared to IV route, SC route maintains higher trough levels of
 immunoglobulins, increases patient independence, reduces systemic side-effects, and is better
 tolerated in those who are pregnant or sensitized to IgA (Radinsky et al, 2003). In a review
 of side effects associated with 33,168 SCIG infusions, no severe or anaphylactoid reactions
 occurred (Gardulf et al, 1995). Patients can self-administer medication, and hence, overall
 cost may be reduced. A retrospective study of 28 children with primary immunodeficiency in
 Canada showed that the mean difference in costs between IVIG and SCIG during the study period
 (1 year on IVIG and 1 year on SCIG) was $4,346 in favor of SCIG (Ducruet et al, 2011). A
 US$10,100 reduction in cost per year per patient associated with SCIG use was also reported
 by Gardulf et al (1995) in Sweden. Disadvantages of SCIG include more frequent infusions and
 local reactions at sites of infusion (transient swelling, soreness, redness, induration,
 local heat, and itching) in about 1% of patients.
Inclusion Criteria:

 To qualify, a patient must have CIDP and persistence of significant symptoms (having 2 or
 more of the following):

 -  Weakness in any limb,

 -  Motor fatigue significant to interfere with ADL or work,

 -  Paresthesia of sufficient severity to require a medication,

 -  Sensory impairment,

 -  Walking impairment,

 AND requires IVIG to control symptoms.

 Exclusion Criteria:

 1. Thrombocytopenia or other bleeding disorders,

 2. Anticoagulation therapy,

 3. Severe or anaphylactoid reactions to IVIG,

 4. Cancer,

 5. Pregnancy,

 6. Breast-feeding,

 7. Renal insufficiency or failure,

 8. Congestive heart failure,

 9. Psychiatric illness.