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Rider NL, Kutac C, Hajjar J, Scalchunes C, Seeborg FO, Boyle M, Orange JS. Health-Related Quality of Life in Adult Patients with Common Variable Immunodeficiency Disorders and Impact of Treatment. J Clin Immunol 2017; 37:461-475. [PMID: 28536745 PMCID: PMC5489588 DOI: 10.1007/s10875-017-0404-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/11/2017] [Indexed: 11/08/2022]
Abstract
PURPOSE Common variable immunodeficiency disorder (CVID) is a primary immunodeficiency disease (PIDD) often associated with severe and chronic infections. Patients commonly receive immunoglobulin (Ig) treatment to reduce the cycle of recurrent infection and improve physical functioning. However, how Ig treatment in CVID affects quality of life (QOL) has not been thoroughly evaluated. The purpose of a recent Immune Deficiency Foundation (IDF) mail survey was to assess the factors that are associated with QOL in patients with CVID receiving Ig treatment. METHODS A 75-question survey developed by the IDF and a 12-item Short Form Health Survey (SF-12) to assess QOL were mailed to adults with CVID. Mean SF-12 scores were compared between patients with CVID and the general US adult population normative sample. RESULTS Overall, 945 patients with CVID completed the surveys. More than half of the patients (54.9%) received intravenous Ig and 44.9% received subcutaneous Ig treatment. Patients with CVID had significantly lower SF-12 scores compared with the general US population regardless of sex or age (p < 0.05). Route of IgG replacement did not dramatically improve QOL. SF-12 scores were highest in patients with CVID who have well-controlled PIDD, lacked physical impairments, were not bothered by treatment, and received Ig infusions at home. CONCLUSION These data provide insight into what factors are most associated with physical and mental health, which can serve to improve QOL in patients in this population. Improvements in QOL can result from early detection of disease, limiting digestive system disease, attention to fatigue, and implementation of an individual treatment plan for the patient.
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Affiliation(s)
- Nicholas L Rider
- Texas Children's Hospital and Baylor College of Medicine, 1102 Bates St, Houston, TX, 77030, USA.
- Section of Immunology, Allergy and Rheumatology, Texas Children's Hospital, 1102 Bates St, Suite 330, Houston, TX, 77030, USA.
| | - Carleigh Kutac
- Immune Deficiency Foundation, 110 West Road, Suite 300, Towson, MD, 21204, USA
| | - Joud Hajjar
- Texas Children's Hospital and Baylor College of Medicine, 1102 Bates St, Houston, TX, 77030, USA
| | - Chris Scalchunes
- Immune Deficiency Foundation, 110 West Road, Suite 300, Towson, MD, 21204, USA
| | - Filiz O Seeborg
- Texas Children's Hospital and Baylor College of Medicine, 1102 Bates St, Houston, TX, 77030, USA
| | - Marcia Boyle
- Immune Deficiency Foundation, 110 West Road, Suite 300, Towson, MD, 21204, USA
| | - Jordan S Orange
- Texas Children's Hospital and Baylor College of Medicine, 1102 Bates St, Houston, TX, 77030, USA
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Quality of Life, Treatment Beliefs, and Treatment Satisfaction in Children Treated for Primary Immunodeficiency with SCIg. J Clin Immunol 2017; 37:496-504. [PMID: 28597145 DOI: 10.1007/s10875-017-0409-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 12/13/2022]
Abstract
Despite the development of subcutaneous treatment, children and adolescents with primary immunodeficiency (PID) are vulnerable to a lower quality of life (QoL) than non-clinical participants. Comparisons have been offered in rare reports with limited sample sizes. No description is available of treatment beliefs and treatment satisfaction with standard tools. The objective of this study was to describe a large sample of patients with pediatric PID on QoL, treatment beliefs and satisfaction, and identify perceived benefits and issues of treatment both in children and parents. A mail-back survey was conducted in 60 patients with PID treated with subcutaneous Ig and their parents from a clinic in Montreal (QC, Canada). We used the standardized tools to assess for QoL levels, beliefs of necessity and concerns with treatment, and dimensions of satisfaction. We collected and coded perceived benefits and issues through open-ended questions. We found lower QoL in children with PID than in healthy non-clinical participants (median d = 0.40) and similar QoL levels to children with cancer (median d = 0.12). Participants considered their treatment as less necessary and able to control the illness and less convenient than patients with other conditions. Children were more prone to consider the treatment as convenient (69 vs. 47% p = .028) but reported more discomfort (24 vs. 10% p = .043) than parents. Results suggest a lower-than-expected QoL in pediatric PID. Aspects of the illness and treatment are probably unclear to patients and their families, as necessity beliefs were lower than expected. Educational strategies should be developed and assessed to address this issue.
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Impact of Site of Care on Infection Rates Among Patients with Primary Immunodeficiency Diseases Receiving Intravenous Immunoglobulin Therapy. J Clin Immunol 2017; 37:180-186. [PMID: 28160239 PMCID: PMC5325835 DOI: 10.1007/s10875-017-0371-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/18/2017] [Indexed: 01/31/2023]
Abstract
Purpose Patients with primary immunodeficiency diseases (PIDD) are at increased risk of infection and may require lifelong immunoglobulin G (IgG) replacement. Infection incidence rates were determined for patients with PIDD receiving intravenously administered IgG (IGIV) in a home or hospital outpatient infusion center (HOIC). Methods Data were extracted from a large, US-based, employer-sponsored administrative database. Patients were eligible for analysis if they had ≥1 inpatient or emergency room claim or ≥2 outpatient claims with a PIDD diagnosis between January 2002 and March 2013, 12 months of continuous health plan enrollment prior to index date (i.e., first IGIV infusion date), and 6 months of continuous IGIV at the same site of care after the index date. Incidences of pneumonia (bacterial or viral) and bronchitis (all types) within 7 days of IGIV infusion were retrospectively determined and compared between sites of care. Results A total of 1076 patients were included in the analysis; 51 and 49% received IGIV at home and at an HOIC, respectively. The event/patient-year of pneumonia was significantly lower in patients receiving IGIV at home compared to an outpatient hospital (0.102 vs. 0.216, p = 0.0071). Similarly, the event/patient-year of bronchitis was significantly lower among patients infusing at home compared to an HOIC (0.150 vs. 0.288, p < 0.0001). Conclusions PIDD patients experienced incidence rates for pneumonia and bronchitis that were lower for patients receiving home-based IGIV treatment versus HOIC-based IGIV treatment. The lower infection rates in the home setting suggest that infection risk may be an important factor in site of care selection.
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Spadaro G, Vultaggio A, Alberto Bosi A, Reichert D, Janssen J, Lamacchia D, Nappi L, Pecoraro A, Milito C, Ferraro A, Matucci A, Bacchiarri F, Carrai V, Hibbeler A, Speckman E, Guarnieri C, Bongiovanni S, Quinti I. Rapid infusions of human normal immunoglobulin 50g/l are safe and well tolerated in immunodeficiencies and immune thrombocytopenia. Int Immunopharmacol 2017; 44:38-42. [PMID: 28073042 DOI: 10.1016/j.intimp.2016.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/07/2016] [Accepted: 12/22/2016] [Indexed: 12/16/2022]
Abstract
Intravenous immunoglobulin (IVIg) is accepted as an effective and well-tolerated treatment for primary and secondary immunodeficiencies (ID) and immune thrombocytopenia (ITP). Adverse reactions of IVIg are usually mild, comprising transient flu-like symptoms, change in blood pressure and tachycardia. However IVIg therapy can be burdensome for both patients and healthcare facilities, since the infusion may take up to 4h to administer. The objective of our multicentre, prospective, open-label phase III trial was to evaluate the tolerability and safety of human normal immunoglobulin 50g/l (Ig VENA) at high intravenous infusion rates in adult patients with ID and ITP who had previously tolerated IVIg treatment, by progressively increasing infusion rate up to 8ml/kg/hr. 39 ID patients received three infusions, 5 ITP patients received up to a maximum of 5 infusions for a maximum of 5days. Overall 55 adverse events were reported in 18 patients, and all were mild and self-limiting. Two serious adverse events occurred in ID patients and 1 in an ITP patient; none was fatal or treatment-related. No clinically significant changes or abnormalities were observed in vital signs, laboratory results and HRQoL. In summary, in this study, more rapid IVIg infusions were well tolerated by ID and ITP patients, while maintaining their quality of life, helping to minimise the time spent in outpatient hospital visiting to potentially optimise adherence to treatment.
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Affiliation(s)
- Giuseppe Spadaro
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Napoli, Italy.
| | | | | | | | | | - Donatella Lamacchia
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Napoli, Italy
| | - Liliana Nappi
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Napoli, Italy
| | - Antonio Pecoraro
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Napoli, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Rome, Italy
| | | | | | | | | | | | | | - Chiara Guarnieri
- Clinical Development & Operations, Kedrion S.p.A., Castelvecchio Pascoli (Lucca), Italy
| | - Serena Bongiovanni
- Clinical Development & Operations, Kedrion S.p.A., Castelvecchio Pascoli (Lucca), Italy
| | - Isabella Quinti
- Department of Molecular Medicine, "Sapienza" University of Rome, Italy
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Windegger TM, Lambooy CA, Hollis L, Morwood K, Weston H, Fung YL. Subcutaneous Immunoglobulin Therapy for Hypogammaglobulinemia Secondary to Malignancy or Related Drug Therapy. Transfus Med Rev 2017; 31:45-50. [DOI: 10.1016/j.tmrv.2016.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/28/2016] [Indexed: 01/20/2023]
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Practical Considerations for Self-Administration of Subcutaneous Immunoglobulin G Utilizing Recombinant Human Hyaluronidase, an Advanced Method of Subcutaneous Administration: A Nurse's Perspective. JOURNAL OF INFUSION NURSING 2016; 39:359-368. [PMID: 27828933 DOI: 10.1097/nan.0000000000000182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An approved subcutaneous infusion of immunoglobulin G using recombinant human hyaluronidase (IGHy) allows adult patients with primary immunodeficiency disease to self-administer every 3 to 4 weeks using 1 to 2 subcutaneous infusion site(s). This article reviews the practical considerations for nurses to simplify patient education and training. Key considerations include pump choice and parameters, ancillary supplies, and technique. Patient education includes infusion log upkeep and management of potential reactions. Educational initiatives should be designed to meet specific patient needs. Successful IGHy self-administration depends on proper patient training and continuing interaction between the health care team and the patient to optimize the patient experience.
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Barlogis V, Mahlaoui N, Auquier P, Pellier I, Fouyssac F, Vercasson C, Allouche M, De Azevedo CB, Suarez F, Moshous D, Neven B, Pasquet M, Jeziorski E, Aladjidi N, Schleinitz N, Thomas C, Gandemer V, Mazingue F, Lutz P, Hermine O, Picard C, Blanche S, Michel G, Fischer A. Physical health conditions and quality of life in adults with primary immunodeficiency diagnosed during childhood: A French Reference Center for PIDs (CEREDIH) study. J Allergy Clin Immunol 2016; 139:1275-1281.e7. [PMID: 27697497 DOI: 10.1016/j.jaci.2016.08.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/27/2016] [Accepted: 08/10/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Most children with primary immunodeficiencies (PIDs) now reach adulthood. However, few studies have evaluated their health status and health-related quality of life (HRQoL). OBJECTIVE To investigate long-term morbidity, the French Reference Center for PIDs initiated a prospective multicenter cohort: the French Childhood Immune Deficiency Long-term Cohort. The data collected were used to assess the physical health condition of patients who reached adulthood and the effect on their quality of life. METHODS Patients were asked to complete health status questionnaires. A severity score (grade 1 [mild] to grade 4 [life-threatening]) was assigned to each health condition. The HRQoL of patients was compared with age- and sex-matched French normal values by using the 36-item Short-Form Survey (SF-36) HRQoL questionnaire. RESULTS Among 329 participants, the mean age at evaluation was 27.6 years, with a 21-year mean follow-up after diagnosis; 43% reported at least 1 grade 4 health condition, and 86% reported at least 1 grade 3 (severe) or 4 health condition. Twenty-five (7.6%) patients had been treated for cancer. Compared with the French normal values, adults with PIDs scored significantly lower for all HRQoL domains. HRQoL was strongly associated with the burden of health conditions. The association with grade 4 or grade 3-4 health conditions was highly significant for all physical and mental domains. CONCLUSION Adults with PIDs diagnosed during childhood experienced a heavy burden of health conditions, which affected their HRQoL. Our results emphasize the need to closely monitor this vulnerable population.
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Affiliation(s)
- Vincent Barlogis
- Department of Pediatric Hematology-Oncology, Assistance Publique-Hôpitaux de Marseille, Marseille, France; French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Public Health-EA 3279 Research Unit, University Hospital Marseille, Aix-Marseille University, Marseille, France.
| | - Nizar Mahlaoui
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pediatric Immuno-Haematology and Rheumatology Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR1163, Imagine Institute, Necker Medical School, Sorbonne Paris Cité, University Paris Descartes, Paris, France
| | - Pascal Auquier
- Department of Public Health-EA 3279 Research Unit, University Hospital Marseille, Aix-Marseille University, Marseille, France
| | - Isabelle Pellier
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Pediatric Oncohematology, University Hospital of Angers, Angers, France
| | - Fanny Fouyssac
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Pediatric Hematology-Oncology, University Hospital of Nancy, Nancy, France
| | - Camille Vercasson
- Department of Public Health-EA 3279 Research Unit, University Hospital Marseille, Aix-Marseille University, Marseille, France
| | - Maya Allouche
- Department of Pediatric Hematology-Oncology, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Carolina Brito De Azevedo
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Felipe Suarez
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR1163, Imagine Institute, Necker Medical School, Sorbonne Paris Cité, University Paris Descartes, Paris, France; Adult Hematology Unit, Necker University Hospital, APHP, University Paris Descartes, Paris, France; CNRS ERL8254, Imagine Institute, Necker Medical School, Sorbonne Paris Cité, University Paris Descartes, Paris, France
| | - Despina Moshous
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pediatric Immuno-Haematology and Rheumatology Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR1163, Imagine Institute, Necker Medical School, Sorbonne Paris Cité, University Paris Descartes, Paris, France
| | - Bénédicte Neven
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pediatric Immuno-Haematology and Rheumatology Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR1163, Imagine Institute, Necker Medical School, Sorbonne Paris Cité, University Paris Descartes, Paris, France
| | - Marlène Pasquet
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Département d'Hématologie, Centre Hospitalier Universitaire Toulouse Purpan and INSERM, CRCT, IUCT-Oncopole, Toulouse, France
| | - Eric Jeziorski
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pédiatrie Générale et Infectiologie et Immunologie Clinique, Hôpital Arnaud de Villeneuve, Montpellier University Hospital, Montpellier, France
| | - Nathalie Aladjidi
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Pediatric Hematology and CIC 0005, INSERM CICP, University Hospital of Bordeaux, Bordeaux, France
| | - Nicolas Schleinitz
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Internal Medicine, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Caroline Thomas
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pediatric Hematology-Oncology Unit, Hôpital Mère Enfant, University Hospital of Nantes, Nantes, France
| | - Virginie Gandemer
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Pediatric Hematology/Oncology, University Hospital of Rennes, Rennes, France
| | - Françoise Mazingue
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Pediatrics, Hôpital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Patrick Lutz
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pediatric Hematology-Oncology, EA3430, Strasbourg, France
| | - Olivier Hermine
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR1163, Imagine Institute, Necker Medical School, Sorbonne Paris Cité, University Paris Descartes, Paris, France; Adult Hematology Unit, Necker University Hospital, APHP, University Paris Descartes, Paris, France
| | - Capucine Picard
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pediatric Immuno-Haematology and Rheumatology Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR1163, Imagine Institute, Necker Medical School, Sorbonne Paris Cité, University Paris Descartes, Paris, France
| | - Stéphane Blanche
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pediatric Immuno-Haematology and Rheumatology Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR1163, Imagine Institute, Necker Medical School, Sorbonne Paris Cité, University Paris Descartes, Paris, France
| | - Gérard Michel
- Department of Pediatric Hematology-Oncology, Assistance Publique-Hôpitaux de Marseille, Marseille, France; French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Public Health-EA 3279 Research Unit, University Hospital Marseille, Aix-Marseille University, Marseille, France
| | - Alain Fischer
- French National Reference Center for Primary Immune Deficiency (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pediatric Immuno-Haematology and Rheumatology Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR1163, Imagine Institute, Necker Medical School, Sorbonne Paris Cité, University Paris Descartes, Paris, France; Collège de France, Paris, France
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Viallard JF, Agape P, Barlogis V, Cozon G, Faure C, Fouyssac F, Gaud C, Gourin MP, Hamidou M, Hoarau C, Husseini F, Ojeda-Uribe M, Pavic M, Pellier I, Perlat A, Schleinitz N, Slama B. Treatment with Hizentra in patients with primary and secondary immunodeficiencies: a real-life, non-interventional trial. BMC Immunol 2016; 17:34. [PMID: 27687879 PMCID: PMC5041334 DOI: 10.1186/s12865-016-0169-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 09/13/2016] [Indexed: 12/22/2022] Open
Abstract
Background Although Hizentra is indicated for immunoglobulin replacement therapy in patients with primary and secondary immunodeficiencies, phase III trials have focused on patients with primary immunodeficiencies. In this 9-month, real-life, prospective, non-interventional, longitudinal, multicenter study of patients with primary and secondary immunodeficiencies in France, treatment modalities (primary endpoint), efficacy, safety, tolerability, quality of life, and treatment satisfaction were evaluated using descriptive statistics. Results Starting in January 2012, 117 patients were enrolled (99 adults, 18 children). Secondary immunodeficiencies were present in 48.7 % of patients. At follow-up, injections were administered every 7 days in 92.2 % of patients. Nine patients (7.8 %) were taking Hizentra every 10–14 days. The median dose of Hizentra administered was 0.1 g/kg/injection. Fifty-six patients were administered doses <0.1 g/kg/injection and 13 patients were administered doses >0.2 g/kg/injection. Mean trough IgG titers were 9.0 ± 3.3 g/L (median 8.3 g/L). The mean yearly rate of infection was 1.2 ± 1.9. Mean scores on the Short Form-36 physical and mental component summaries were 46.3 ± 10.0 and 46.6 ± 9.3, respectively. Scores on the Treatment Satisfaction Questionnaire for Medication ranged from 69.9 ± 19.9 to 88.3 ± 21.2 depending on the domain. Treatment with Hizentra was well tolerated. No single drug-related systemic reaction occurred in more than one patient and few local reactions were reported (n = 5). Conclusions Under real-life conditions and in a cohort that included patients with primary and secondary immunodeficiencies, treatment with Hizentra was effective and well tolerated and patients were generally satisfied with the treatment.
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Affiliation(s)
- J F Viallard
- Centre Hospitalier Universitaire Haut-Lévêque, 5, Avenue de Magellan, 33604, Pessac Cedex, France.
| | - P Agape
- Institut de Cancerologie de l'Ouest, 11 Boulevard Jacques Monod, 44800, Saint-Herblain, France
| | - V Barlogis
- CHU de Marseille - Hôpital de la Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - G Cozon
- CHU Edouard Herriot, 5 place d'Arsonval, 69003, Lyon, France
| | - C Faure
- Centre hospitalier intercommunal de la Haute-Saône, 2 rue Heymes BP 409, 70014, Vesoul Cedex, France
| | - F Fouyssac
- CHU de Nancy, 29, avenue du Maréchal de lattre de Tassigny, 54035, Nancy Cedex, France
| | - C Gaud
- Centre hospitalier universitaire Felix Guyon, service d'immunologie clinique, 97405, Saint Denis Cedex Ile de la Reunion, France
| | - M P Gourin
- CHU Limoges, 2, avenue Martin Luther King, 87042, Limoges cedex, France
| | - M Hamidou
- CHU de Nantes - Hôtel Dieu, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - C Hoarau
- Centre hospitalier universitaire de Tours, 37044, Tours Cedex 9, France
| | - F Husseini
- Centre Hospitalier Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024, Colmar cedex, France
| | - M Ojeda-Uribe
- Centre Hospitalier de la région de Mulhouse & Sud Alsace, 87, avenue d'altkirch, 68051, Mulhouse CEDEX, France
| | - M Pavic
- CHU Fleurimont, Sherbrooke, QC, J1H 5N4, Canada
| | - I Pellier
- CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - A Perlat
- CHU de Rennes, 16 bd de Bulgarie, 35200, Rennes, France
| | - N Schleinitz
- CHU la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, France
| | - B Slama
- CH Avignon, 305 rue Raoul Follereau, 84000, Avignon Cedex 9, France
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Bienvenu B, Cozon G, Hoarau C, Pasquet M, Cherin P, Clerson P, Hachulla E, Crave JC, Delain JC, Jaussaud R. Does the route of immunoglobin replacement therapy impact quality of life and satisfaction in patients with primary immunodeficiency? Insights from the French cohort "Visages". Orphanet J Rare Dis 2016; 11:83. [PMID: 27334100 PMCID: PMC4917986 DOI: 10.1186/s13023-016-0452-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/10/2016] [Indexed: 01/12/2023] Open
Abstract
Background IgG replacement therapy (IgRT) in primary immunodeficiencies (PID) is a lifelong treatment which may be administered intravenously (IVIg) or subcutaneously (SCIg), at hospital or at home. The objective of the VISAGE study was to investigate if route and/or place for IgRT impact patients’ satisfaction regarding IgRT and quality of life (QoL) in real-life conditions. Methods The study enrolled PID patients at least 15 years old receiving IgRT for at least 3 months. Satisfaction and QoL were evaluated at enrollment and over a 12-month follow-up period by Life Quality Index (LQI) which measures 3 dimensions of satisfaction: treatment interference, therapy related problems and therapy settings (factors I, II and III) and SF-36 v2 questionnaire. Results The study included 116 PID patients (mean age 42 ± 18 years, 44 % males, 58 % with scholar or professional occupation) receiving IgRT for a mean of 8.5 ± 8.4 years. At enrollment they were receiving either home-based SCIg (51 %), hospital-based IVIg (40 %) or home-based IVIg (9 %). Patients exhibited a high degree of satisfaction regarding IgRT whatever the route and place for administration. LQI factor I was higher for home-based SCIg (86 ± 2) than for hospital-based IVIg (81 ± 3) and home-based IVIg (73 ± 5; p = 0.02 versus home-based SCIg); no difference was found for LQI factor II; LQI factor III was higher for home-based SCIg (92 ± 2) than for hospital-based IVIg (87 ± 5) and hospital-based IVIg (82 ± 3; p = 0.005 versus home-based SCIg). By contrast, every dimension of QoL was impaired. Over the follow-up period, 10 patients switched from hospital-based IVIg to home-based SCIg and improved LQI factor I (p = 0.004) and factor III (p = 0.02), while no change was noticed in LQI factors II and QoL. Meanwhile, no change in satisfaction or QoL was found in patients with stable route of IgRT. When asked on their preferred place of treatment all but one patient with home-based treatment would choose to be treated at home and 29 % of patients treated at hospital would prefer home-based IgRT. Conclusion PID patients expressed a high degree of satisfaction regarding IgRT, contrasting with impaired QoL. In real-life conditions awareness of patient’s expectations regarding the route or place of IgRT may be associated with further improvement of satisfaction.
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Affiliation(s)
- B Bienvenu
- Internal Medicine Department, University Hospital Centre of Caen, avenue de la Côte de Nacre, BP 95182, 14033, Caen cedex 9, France.
| | - G Cozon
- Edouard Herriot Hospital, Clinical Immunology, 5 place d'Arsonval, 69437, Lyon cedex 03, France
| | - C Hoarau
- Renal Transplantation & Clinical immunology Department, University Hospital Centre of Tours, 2 bd Tonnellé, 37044, Tours cedex, France
| | - M Pasquet
- Pediatric Hematology and Oncology Department, University Hospital Centre of Toulouse, 330 avenue de la Grande Bretagne, 31059, Toulouse cedex 9, France
| | - P Cherin
- Internal Medicine Department, Saint Antoine Hospital, 184 rue du Faubourg Saint Antoine, 75571, Paris cedex 12, France
| | - P Clerson
- Soladis Clinical Studies, 84 boulevard du Général Leclerc, 59100, Roubaix, France
| | - E Hachulla
- Internal medecine Department, CHRU Lille - Hôpital Claude Huriez, 2 avenue Oscar Lambret, 59037, Lille Cedex, France
| | - J C Crave
- Octapharma France, 62bis avenue André Morizet, 92100, Boulogne-Billancourt, France
| | - J C Delain
- Octapharma France, 62bis avenue André Morizet, 92100, Boulogne-Billancourt, France
| | - R Jaussaud
- Internal Medicine and Infectious Diseases Department, University Hospital Centre of Reims, avenue du Gal Koenig, 51092, Reims cedex, France
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Tichy EM, Vaughan L. Selecting a polyclonal immune globulin treatment for a patient with primary immune deficiency disease: Role of the clinical pharmacist. Am J Health Syst Pharm 2016; 73:533-46. [DOI: 10.2146/ajhp150320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eric M. Tichy
- Clinical Pharmacy Services, Yale-New Haven Hospital, New Haven, CT
| | - Leslie Vaughan
- Clinical Programs, NuFACTOR Specialty Pharmacy, Temecula, CA
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Gardulf A. Clinical experiences in primary and secondary immunodeficiencies and immune-mediated conditions using Gammanorm(®). Immunotherapy 2016; 8:633-47. [PMID: 27020964 DOI: 10.2217/imt-2015-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Treatment for primary and secondary immunodeficiency disorders focuses on prevention and management of infections, using immunoglobulin G (IgG) replacement therapy with regular intravenous or subcutaneous IgG (SCIG) infusions. SCIG therapy has many advantages including improved efficacy and tolerability, enhanced patient satisfaction and lower costs. A number of SCIG preparations are available, including Gammanorm(®) (Octapharma AG), a ready-to-use 16.5% liquid preparation of IgG, with low viscosity, well suited to self-administration and a long history of use. Clinical experience with Gammanorm has shown that it is effective and well tolerated in children and adults, including pregnant women, for primary and secondary immunodeficiency disorders. Recent data also suggest SCIG may have a role in the treatment of certain immune-mediated conditions.
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Affiliation(s)
- Ann Gardulf
- The Unit for Clinical Nursing Research & Clinical Research in Immunotherapy, Division of Clinical Immunology, Department of Laboratory Medicine and Transfusion Medicine, Karolinska Institutet, SE-141 83 Huddinge, Stockholm, Sweden.,The Japanese Red Cross Institute for Humanitarian Studies, Tokyo, Japan
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Jiang F, Torgerson TR, Ayars AG. Health-related quality of life in patients with primary immunodeficiency disease. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2015; 11:27. [PMID: 26421019 PMCID: PMC4587876 DOI: 10.1186/s13223-015-0092-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/01/2015] [Indexed: 12/31/2022]
Abstract
Primary immunodeficiency disease (PIDD) with hypogammaglobulinemia is characterized by recurrent and severe bacterial infections and IgG replacement is the standard of care in many of these patients. Health-related quality of life (HRQOL) is becoming increasingly recognized as a factor that affects patient well-being and treatment preferences. In an effort to better understand what factors affect HRQOL in patients with PIDD, we reviewed the published literature that used standardized instruments for the measurement of HRQOL. We investigated HRQOL in PIDD patients compared with normal controls and patients with other chronic diseases; we also investigated the impact of treatment administration on patient satisfaction. The most commonly encountered health-related quality of life instruments were the child heath questionnaire parental form 50, short form 36, PedsQL 4.0, Lansky's play performance scale, and Life Quality Index. Patients with PIDD scored significantly lower on many of the instruments compared with normal controls. Also, while it appears that many patients appreciate home-based and subcutaneous IgG replacement therapy, patient satisfaction ultimately involves various clinical factors and individual patient preferences. By further analyzing what factors impact HRQOL, therapy adjustments can be made to maximize patient well-being and minimize disease impact on daily functioning.
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Affiliation(s)
- Fonda Jiang
- />University of Washington, Seattle, WA USA
- />Center for Allergy and Inflammation UW Medicine at South Lake Union, 850 Republican Street, Seattle, WA 98109-4725 USA
| | - Troy R. Torgerson
- />University of Washington, Seattle, WA USA
- />Seattle Children’s Hospital, Seattle, WA USA
| | - Andrew G. Ayars
- />University of Washington, Seattle, WA USA
- />Seattle Children’s Hospital, Seattle, WA USA
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Elstein D, Abrahamov A, Oz A, Arbel N, Baris H, Zimran A. 13,845 home therapy infusions with velaglucerase alfa exemplify safety of velaglucerase alfa and increased compliance to every-other-week intravenous enzyme replacement therapy for Gaucher disease. Blood Cells Mol Dis 2015; 55:415-8. [PMID: 26460268 DOI: 10.1016/j.bcmd.2015.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lifelong intravenous (IV) enzyme replacement therapy (ERT) every other week for Gaucher disease is appreciated as decreasing quality of life in a palpable way. OBJECTIVE To review the Israeli experience with the home therapy option for IV velaglucerase alfa (Shire, Lexington MA USA) infusions every-other-week in the clinical trial context, in the early access program (EAP) during a shortage with the standard commercial ERT, and currently with the commercially available drug (VPRIV, Shire). RESULTS Among 24 patients participating in trials, 1654 infusions were at home; in the EAP and commercial setting, 12,191 infusions were performed at home for a total of 154 patients with 98.4% compliance. There were no incidents of serious adverse events. CONCLUSION This is the first review of experience of 174 patients and 13,845 intravenous infusions of velaglucerase alfa for Gaucher in the home setting, underscoring its safety.
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Affiliation(s)
- Deborah Elstein
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Aya Abrahamov
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anat Oz
- Medison Pharma Ltd, Petach Tikva, Israel
| | | | - Hagit Baris
- Genetics Institute, Rambam Medical Center, Haifa, Israel
| | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
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Efficacy and Safety of Hospital-Based Intravenous Immunoglobulin and Home-Based Self-Administered Subcutaneous Immunoglobulin in Polish Children with Primary Immunodeficiency Diseases. Indian J Pediatr 2015; 82:768-9. [PMID: 25786586 DOI: 10.1007/s12098-015-1731-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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Jolles S, Jordan SC, Orange JS, van Schaik IN. Immunoglobulins: current understanding and future directions. Clin Exp Immunol 2015; 178 Suppl 1:163-8. [PMID: 25546806 DOI: 10.1111/cei.12555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- S Jolles
- University Hospital of Wales, Cardiff, UK
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Chapel H, Prevot J, Gaspar HB, Español T, Bonilla FA, Solis L, Drabwell J, The Editorial Board for Working Party on Principles of Care at IPOPI. Primary immune deficiencies - principles of care. Front Immunol 2014; 5:627. [PMID: 25566243 PMCID: PMC4266088 DOI: 10.3389/fimmu.2014.00627] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/24/2014] [Indexed: 12/01/2022] Open
Abstract
Primary immune deficiencies (PIDs) are a growing group of over 230 different disorders caused by ineffective, absent or an increasing number of gain of function mutations in immune components, mainly cells and proteins. Once recognized, these rare disorders are treatable and in some cases curable. Otherwise untreated PIDs are often chronic, serious, or even fatal. The diagnosis of PIDs can be difficult due to lack of awareness or facilities for diagnosis, and management of PIDs is complex. This document was prepared by a worldwide multi-disciplinary team of specialists; it aims to set out comprehensive principles of care for PIDs. These include the role of specialized centers, the importance of registries, the need for multinational research, the role of patient organizations, management and treatment options, the requirement for sustained access to all treatments including immunoglobulin therapies and hematopoietic stem cell transplantation, important considerations for developing countries and suggestions for implementation. A range of healthcare policies and services have to be put into place by government agencies and healthcare providers, to ensure that PID patients worldwide have access to appropriate and sustainable medical and support services.
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Affiliation(s)
| | - Johan Prevot
- International Patient Organisation for Primary Immunodeficiencies (IPOPI), Downderry, UK
| | | | | | | | - Leire Solis
- International Patient Organisation for Primary Immunodeficiencies (IPOPI), Downderry, UK
| | - Josina Drabwell
- International Patient Organisation for Primary Immunodeficiencies (IPOPI), Downderry, UK
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Tabolli S, Giannantoni P, Pulvirenti F, La Marra F, Granata G, Milito C, Quinti I. Longitudinal study on health-related quality of life in a cohort of 96 patients with common variable immune deficiencies. Front Immunol 2014; 5:605. [PMID: 25505470 PMCID: PMC4244641 DOI: 10.3389/fimmu.2014.00605] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/11/2014] [Indexed: 01/09/2023] Open
Abstract
Health-related quality of life (HRQoL) in common variable immunodeficiency diseases (CVID) was evaluated by different tools, which were mainly used to compare different schedules of immunoglobulins administration in cross-sectional or short-term longitudinal studies. We assessed the HRQoL and psychological status of CVID patients in a longitudinal study over a 6-year period by a generic, non-disease-specific instrument (SF-36), and by a General Health Questionnaire (GHQ-12) for the risk of depression/anxiety. At baseline, 96 patients were enrolled. After 1 year, a second assessment was performed on 92 patients and, after 6 years, a third assessment was performed on 66 patients. Eighteen patients died during the study time. HRQoL was low, with mental health scales less affected than physical scales. A decline in the score on SF-36 scales was observed between the first and the third assessment for the Physical Functioning, Body Pain, General Health, Social Functioning, and Role-Emotional scales. The General Health scale showed a lower score in these patients, when compared to patients with other chronic diseases. Approximately one-third of the patients were at risk of anxiety/depression at all observation times, a percentage that reached two thirds of the patients, considering only the group of females. Over the 6 years of the study, the health condition of 11/66 patients worsened, passing from “GHQ-negative” to “GHQ-positive”; their score on SF-36 scales also decreased. A decrement of one point in each of the Physical Functioning, Vitality, Social Functioning, and Mental Health SF-36 scales increased the risk of developing anxiety/depression from three to five percent. A negative variation of the Physical Functioning score increased the risk of psychological distress. In a survival analysis with dichotomized variables, Physical Functioning scores <50 were associated with a relative risk (RR) of 4.4, whereas Social Functioning scores <37.5 were associated with a RR of 10.0. In our study, it was the clinical condition, as opposed to the different treatment strategies with immunoglobulins, which had a major role on the deterioration of HRQoL. Moreover, in a quality-of-life evaluation, disorders such as anxiety/depression should be assessed, as they yet often go unrecognized. Our results might be helpful in the interpretation of currently available data on quality of life in CVID patients.
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Affiliation(s)
- Stefano Tabolli
- Health Services Research Unit, Istituto Dermopatico dell'Immacolata (IDI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) , Rome , Italy
| | - Patrizia Giannantoni
- Health Services Research Unit, Istituto Dermopatico dell'Immacolata (IDI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) , Rome , Italy
| | - Federica Pulvirenti
- Department of Molecular Medicine, Sapienza University of Roma , Rome , Italy
| | - Fabiola La Marra
- Department of Molecular Medicine, Sapienza University of Roma , Rome , Italy
| | - Guido Granata
- Department of Molecular Medicine, Sapienza University of Roma , Rome , Italy
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Roma , Rome , Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Roma , Rome , Italy
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A glance on recent progresses in diagnosis and treatment of primary immunodeficiencies/ Progrese recente în diagnosticul şi tratamentul imunodeficienţelor primare. REV ROMANA MED LAB 2014. [DOI: 10.2478/rrlm-2014-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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