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Xiao N, Huang X, Yang D, Zang W, Kiselev S, Bolkov MA, Shinwari K, Tuzankina I, Chereshnev V. Health-related quality of life in patients with inborn errors of immunity: A systematic review and meta-analysis. Prev Med 2024; 186:108079. [PMID: 39053518 DOI: 10.1016/j.ypmed.2024.108079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Inborn Errors of Immunity (IEI) significantly affect patients' health-related quality of life (HRQOL), presenting greater challenges than those faced by the healthy population and other chronic disease sufferers. Current research lacks comprehensive integration of this critical issue. OBJECTIVE This study explores HRQOL in IEI patients, identifies impacting factors, and advocates for increased research focus on their quality of life. METHODS Following systematic review and meta-analysis guidelines, a search of Scopus and PubMed until November 15, 2023, yielded 1633 publications. We evaluated the literature, assessed study quality, and compared the HRQOL of IEI patients to that of healthy individuals and other chronic disease patients. RESULTS Of 90 articles and 10,971 IEI patients analyzed, study quality varied (nine good, 63 moderate, and 18 poor). The Short Form-36 (SF-36) and Pediatric Quality of Life Inventory generic core scales (PedsQL) were the primary generic instruments used among adults and children, respectively, with 12 studies each using the disease-specific instruments. Meta-analysis showed IEI patients have significantly lower scores in general health, physical and mental health, and social and emotional roles compared to healthy populations. We noted significant differences between self and proxy reports, indicating caregiver anxiety and perception disparities. CONCLUSION Despite limitations like small sample sizes and reliance on generic instruments, this research underscores the substantially lower HRQOL among IEI patients, emphasizing the need for a patient-centered, multidisciplinary approach to improve their life quality and calling for more focused attention on IEI patients and their caregivers' HRQOL.
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Affiliation(s)
- Ningkun Xiao
- Department of Immunochemistry, Institution of Chemical Engineering, Ural Federal University, Yekaterinburg, Russia; Laboratory for Brain and Neurocognitive Development, Department of Psychology, Institution of Humanities, Ural Federal University, Yekaterinburg, Russia.
| | - Xinlin Huang
- Laboratory for Brain and Neurocognitive Development, Department of Psychology, Institution of Humanities, Ural Federal University, Yekaterinburg, Russia.
| | - Dandan Yang
- Guang'an District Women and Children's Hospital, Guang'an, China
| | - Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China.
| | - Sergey Kiselev
- Laboratory for Brain and Neurocognitive Development, Department of Psychology, Institution of Humanities, Ural Federal University, Yekaterinburg, Russia.
| | - Mikhail A Bolkov
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Khyber Shinwari
- Department Biology, Nangrahar University, Nangrahar, Afghanistan
| | - Irina Tuzankina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Valery Chereshnev
- Department of Immunochemistry, Institution of Chemical Engineering, Ural Federal University, Yekaterinburg, Russia; Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.
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King C, Ridge K, Smyth J, Flinn AM, Leahy TR, Conlon N. Experience of pediatric to adult transition in immunology services: patient experience questionnaire and micro-costing analysis. Front Immunol 2024; 15:1270451. [PMID: 38510252 PMCID: PMC10952820 DOI: 10.3389/fimmu.2024.1270451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
The effective transition from pediatric to adult care for individuals with chronic medical conditions should address the medical, psychosocial and educational needs of the cohort. The views and experiences of service users and their families are an integral component of service development. This study sought to evaluate the current provision of transition services from pediatric immunology services to adult immunology services for patients with a diagnosis of an inborn error of immunity at St. James's Hospital, Dublin. We gathered patient perspectives on the experience of the transition process using a structured survey. In addition, we adopted a micro-costing technique to estimate the cost of implementing the current standard of care for these patients. Results of a micro-costing analysis suggest that the most significant component of cost in assessing these patients is on laboratory investigation, an area where there is likely significant duplication between pediatric and adult care. Perspectives from patients suggested that the transition period went well for the majority of the cohort and that they felt ready to move to adult services, but the transition was not without complications in areas such as self-advocacy and medication management. The transition process may benefit from enhanced communication and collaboration between pediatric and adult services.
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Affiliation(s)
- Catherine King
- Diagnostic and Clinical Immunology, St. James’s Hospital, Dublin, Ireland
| | - Katie Ridge
- Diagnostic and Clinical Immunology, St. James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - James Smyth
- Finance Department, St. James’s Hospital, Dublin, Ireland
| | - Aisling M. Flinn
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Pediatric Immunology, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Pediatric Immunology, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Niall Conlon
- Diagnostic and Clinical Immunology, St. James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Harmon M, Riazi K, Callum J, Arnold DM, Barty R, Sidhu D, Heddle NM, MacLeod L, Li N. Immunoglobulin utilization in Canada: a comparative analysis of provincial guidelines and a scoping review of the literature. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:85. [PMID: 37717038 PMCID: PMC10504792 DOI: 10.1186/s13223-023-00841-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Canada has high immunoglobulin (IG) product utilization, raising concerns about appropriate utilization, cost and risk of shortages. Currently, there is no national set of standardized IG guidelines, and considerable variations exist among the existing provincial guidelines. The aims of this study were: (1) to compare the existing Canadian provincial guidelines on the use of IG products to identify their consistencies and differences and (2) to examine the existing research in Canada on IG supply and utilization following the establishment of IG guidelines to understand the scope of research and pinpoint the gaps. METHODS A comparative analysis accounted for the differences across provincial IG guidelines. We highlighted similarities and differences in recommendations for medical conditions. A scoping review of citations from MEDLINE, PubMed, Scopus and Embase databases was conducted for studies published from January 01, 2014, to April 12, 2023. RESULTS While provincial guidelines represented a considerable overlap in the medical conditions delineated and relatively uniform dose calculations, numerous differences were observed, including in recommendation categories, provision of pediatric dosing, and divergent recommendations for identical conditions based on patient demographics. The scoping review identified 29 studies that focused on the use of IG in Canada. The themes of the studies included: IVIG utilization and audits, the switch from IVIG to SCIG, patient satisfaction with IVIG and/or SCIG, the economic impact of self-administered SCIG versus clinically administered IVIG therapy, and the efficacy and cost-effectiveness of alternative medications to IG treatment. CONCLUSION The differences in guidelines across provinces and the factors influencing IVIG/SCIG use, patient satisfaction, and cost savings are highlighted. Future research may focus on clarifying costs and comparative effectiveness, exploring factors influencing guideline adherence, and evaluating the impact of updated guidelines on IG use and patient outcomes.
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Affiliation(s)
- Megan Harmon
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, CWPH 5E37, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Kiarash Riazi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, CWPH 5E37, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Donald M Arnold
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rebecca Barty
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Ontario Regional Blood Coordinating Network, Hamilton, ON, Canada
| | - Davinder Sidhu
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nancy M Heddle
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada
| | - Laurie MacLeod
- Ontario Regional Blood Coordinating Network, Hamilton, ON, Canada
| | - Na Li
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, CWPH 5E37, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
- Department of Computing and Software, McMaster University, Hamilton, ON, Canada.
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Visser E, Fraaij P, Hoogenboom A, Witkamp E, van der Knaap L, van Rossum A, Stol K, Vermont C. Prevalence and Impact of Fatigue in Children with Primary Immunodeficiency Disorders: a Quantitative Single-Center Study. J Clin Immunol 2022; 42:1223-1229. [PMID: 35536474 PMCID: PMC9537115 DOI: 10.1007/s10875-022-01282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/26/2022] [Indexed: 12/04/2022]
Abstract
Although fatigue is a common symptom in adult patients with primary immunodeficiencies (PID), data in pediatric patients are limited. The goal of this study is to estimate the prevalence and impact of fatigue in children with PID as reported by patients, parents, and health-care providers. A retrospective single-center observational study was performed. Prevalence of fatigue was measured by reviewing medical charts of 54 children in our department who are on immunoglobulin replacement therapy. Both prevalence and impact were also measured by the PedsQL-Multidimensional Fatigue Scale (MFS) in 27 patients and 32 of their parents. This is an age-appropriate questionnaire for self-report of fatigue symptoms in patients aged 5–18 years and for parent proxy reports for patients aged 2–18 years. General, cognitive, and sleep-rest fatigue was measured, and a total fatigue score was calculated. Means, standard deviation and Z scores were calculated using age-specific reference values. Intraclass correlation coefficients (ICC) were calculated for comparison of scores provided by parents vs children’s self-reported scores. Both chart review data and PedsQL-MFS showed fatigue rates of 65%. Pediatric PID patients of all ages had significantly lower scores on all subscales and total score of the PedsQL-MFS compared to healthy children, indicating greater perceived symptoms of fatigue. General fatigue was the most affected subscale in PID patients, suggesting that fatigue in these patients is mainly physical. Seventy-four percent of PID patients had a Z score lower than − 1 on the general fatigue subscale indicating severe fatigue. Child-parent concordance varied between 0.24 and 0.93. Our results show the feasibility of the PedsQL-MFS survey to evaluate the prevalence and severity of fatigue in children with PID and underscore the importance of this issue in our patient care.
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Affiliation(s)
- Eline Visser
- Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pieter Fraaij
- Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annemieke Hoogenboom
- School of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Erica Witkamp
- School of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Linda van der Knaap
- Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annemarie van Rossum
- Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kim Stol
- Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Clementien Vermont
- Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Rondeau É, Desjardins L, Laverdière C, Sinnett D, Haddad É, Sultan S. French-language adaptation of the 16D and 17D Quality of Life measures and score description in two Canadian pediatric samples. Health Psychol Behav Med 2021; 9:619-635. [PMID: 34285826 PMCID: PMC8266233 DOI: 10.1080/21642850.2021.1948416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/19/2021] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The Health state descriptive system includes standardized self-administered instruments for measuring Health-Related Quality of Life (HRQoL) respectively among adolescents, and children. The objectives of the current study were: (1) to translate and adapt the pediatric-adolescent version 16D and 17D from English into French (Canada), (2) to demonstrate their feasibility in pediatric conditions. METHODS The translation methodology combined forward and back translations, and cognitive debriefing with eight adolescents and eight children. Four bilingual translators were involved in the process. We administered the translated versions to two clinical samples, being treated for Primary immunodeficiency (PID, n = 48, aged 14.1 years, 20 girls), and having recovered from pediatric Acute Lymphoblastic Leukemia (ALL, n = 153, aged 14.7 years, 77 girls). RESULTS Cognitive debriefing indicated that that the instructions, items, and response options were clear, easy to understand, and easy to answer. Adjustments were made for clarity. Translated versions were highly usable (measurement completion >90%). HRQoL levels were high for both samples (range 0.85-0.96). Participants reported lower levels if they were adolescents, particularly if they were girls. Older boys with PID reported a lower HRQoL than their counterparts with a history of ALL. PID and ALL patients mainly reported issues with discomfort and pain, concentration/learning, physical appearance, and psychological distress and sleeping, although to a different degree. CONCLUSION The French-language versions of the 16D and 17D are easy to administer and may be used to identify problematic domains. Greater availability of translated versions of short evaluation tools may facilitate broader uptake of screening practices in pediatric care.
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Affiliation(s)
| | | | - Caroline Laverdière
- Sainte-Justine UHC Research Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Daniel Sinnett
- Sainte-Justine UHC Research Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Élie Haddad
- Sainte-Justine UHC Research Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Serge Sultan
- Sainte-Justine UHC Research Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
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Kobayashi RH, Mandujano JF, Rehman SM, Kobayashi AL, Geng B, Atkinson TP, Melamed I, Turpel-Kantor E, Clodi E, Gupta S. Treatment of children with primary immunodeficiencies with a subcutaneous immunoglobulin 16.5% (cutaquig ® [octanorm]). Immunotherapy 2021; 13:813-824. [PMID: 33955240 DOI: 10.2217/imt-2021-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Subcutaneous human immunoglobulin (16.5%; octanorm/cutaquig®) was efficacious and well tolerated in patients with primary immunodeficiencies in a Phase III study. A subanalysis of pediatric data is presented here. Materials & methods: Children (2-16 years) previously treated with intravenous human immunoglobulin received weekly subcutaneous human immunoglobulin infusions over 64 weeks. The main objective was to assess the efficacy of cutaquig in preventing serious bacterial infections. Results: 38 children received 2213 infusions of cutaquig. No serious bacterial infections developed during the study. The rate of other infections was 3.1 per person-year and the rate of adverse drug reactions was 0.083 per infusion. Higher immunoglobulin G trough levels were achieved with cutaquig compared with previous intravenous therapy. Conclusion: Once-weekly infusions of cutaquig were efficacious and well tolerated in children with primary immunodeficiencies.
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Affiliation(s)
- Roger H Kobayashi
- Department of Pediatrics, Division of Immunology and Allergy, UCLA School of Medicine, Los Angeles, CA 90095, USA
| | | | - Syed M Rehman
- Asthma & Allergy Center, Inc., Toledo, OH 43617, USA
| | | | - Bob Geng
- Divisions of Adult and Pediatric, Allergy and Immunology, University of California-San Diego, La Jolla, CA 92093, USA
| | - Thomas Prescott Atkinson
- Department of Pediatric Allergy, Asthma and Immunology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Eva Turpel-Kantor
- Octapharma Pharmazeutika Produktionsges, m.b.H., Vienna, 1100, Austria
| | - Elisabeth Clodi
- Octapharma Pharmazeutika Produktionsges, m.b.H., Vienna, 1100, Austria
| | - Sudhir Gupta
- Division of Basic and Clinical Immunology, University of California, Irvine, CA 92697, USA
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Berg AK, Diseth TH, Abrahamsen TG, Halvorsen K, Reinfjell T, Erichsen HC. Primary antibody deficiency: The impact on the quality of life and mental health of affected children and their parents. Acta Paediatr 2021; 110:1645-1652. [PMID: 33420742 DOI: 10.1111/apa.15752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/24/2020] [Accepted: 01/07/2021] [Indexed: 01/14/2023]
Abstract
AIM To evaluate health-related quality of life, mental health and treatment-related stress responses in children with primary antibody deficiency and both their parents. METHODS Children and their parents completed the standardised questionnaires Pediatric Quality of life Inventory, Strength and Difficulties Questionnaire and Impact of Event Scale. Parents also completed standardised questionnaires regarding their own mental health and quality of life. The results were compared to those of healthy children, kidney transplanted children and children in remission from acute lymphoblastic leukaemia. RESULTS Children with primary antibody deficiency reported a poorer health-related quality of life compared to healthy children and children in remission from acute lymphoblastic leukaemia. They reported poorer mental health compared with healthy children. Mothers of children with primary antibody deficiency reported poorer mental health compared to mothers of healthy children but comparable to mothers of chronically ill children. Parents reported a similar quality of life as the general Norwegian population. Treatment with subcutaneous immunoglobulin infusions at home is generally well tolerated, but some report severe treatment-related stress. CONCLUSION Primary antibody deficiency has a significant impact on quality of life and mental health of affected children. Patients and parents with severe treatment-related stress should be identified and helped.
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Affiliation(s)
| | - Trond H. Diseth
- Division of Paediatrics and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Tore Gunnar Abrahamsen
- Division of Paediatrics and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Kathleen Halvorsen
- Division of Paediatrics and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Trude Reinfjell
- Department of Psychology Norwegian University of Science and Technology Trondheim Norway
| | - Hans Christian Erichsen
- Division of Paediatrics and Adolescent Medicine Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
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Moschese V, Canessa C, Trizzino A, Martire B, Boggia GM, Graziani S. Pediatric subset of primary immunodeficiency patients treated with SCIG: post hoc analysis of SHIFT and IBIS pooled data. Allergy Asthma Clin Immunol 2020; 16:80. [PMID: 32944034 PMCID: PMC7491303 DOI: 10.1186/s13223-020-00478-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/29/2020] [Indexed: 12/30/2022] Open
Abstract
Background Primary immunodeficiencies (PID) constitute a heterogeneous group of more than 350 monogenetic diseases. PID patients with antibody impairment require lifelong administration of immunoglobulin G replacement therapy, administered either intravenously (IVIG) or subcutaneously (SCIG). Although the effectiveness of weekly and biweekly (every other week) SCIG administration has been shown in several trials, data on the viability of these two regimens in pediatric PID patients are sparse. Methods Data on the pediatric subsets of PID patients enrolled in SHIFT (weekly) and IBIS (biweekly) studies were pooled and analyzed to indirectly compare two different 20%-concentrated SCIG (Hizentra®) regimens. The primary endpoints were to evaluate trough IgG levels and cumulative monthly doses; the secondary endpoint was to analyze incidence of infections. Results Fifteen and 13 children from the SHIFT and IBIS studies were included, respectively. Cumulative 20%-concentrated SCIG monthly dose was slight lower for the biweekly regimen (Δ = − 2.04, 90% CI − 8.3 to 4.23). However, the trough IgG levels were similar between the two groups (Δ = 0.28, 90% CI − 0.51 to 1.07) and constantly above the threshold of 5 g/L. After adjusting for potential confounders, the annualized rate of infections was similar between SHIFT and IBIS patients (incidence rate ratio = 1.09, 90% CI 0.72–1.67); only 1 serious bacterial infection was experienced by a patient in the IBIS group. Conclusion In pediatric PID patients, weekly and biweekly Hizentra® administrations appeared equally effective treatment options.
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Affiliation(s)
- Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy
| | - Clementina Canessa
- Pediatric Immunology Meyer Children's Hospital University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
| | - Antonino Trizzino
- Department of Pediatric Hematology and Oncology, ARNAS Civico Di Cristina and Benfratelli Hospital, Palermo, Italy
| | - Baldassarre Martire
- Pediatric Unit, "Mons. Dimiccoli" Hospital, Viale Ippocrate, 70051 Barletta, Italy
| | | | - Simona Graziani
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy
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Ridao-Manonellas S, Fábregas-Bofill A, Núñez-Rueda G, González-Amores M, García-Prat M, López-Seguer L, Rivière JG, Martín-Nalda A, Mendoza-Palomar N, Melendo-Pérez S, Soler-Palacín P. Health-Related Quality of Life and Multidimensional Fatigue Scale in Children with Primary Immunodeficiencies. J Clin Immunol 2020; 40:602-609. [PMID: 32291562 DOI: 10.1007/s10875-020-00775-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Patients with primary immunodeficiency disease (PID) have an increased risk of experiencing physical activity limitations, social difficulties, and psychological problems due to their chronic condition. Evaluation of their health-related quality of life (HRQOL) and fatigue is crucial in these patients to help understand their complex disease and provide adequate medical care. METHODS In this study, we evaluated HRQOL and fatigue in pediatric and young adult patients with PID attending our center. Participants completed the Pediatric Quality of Life Inventory (PedsQL), version 4.0, and the PedsQL multidimensional fatigue module, standard version. RESULTS Fifty-three PID patients were recruited (age range: 2-23 years). The mean HRQOL score obtained was 66.61 (SD: 18.73) out of 100, and the emotional and work/school dimensions were the ones most highly affected. There were no significant differences in reported quality of life between patients and their caregivers. The mean patient-reported fatigue value was 68.81 (SD: 17.80) out of 100, and the rest-related dimension was the one most highly affected. In the caregivers' assessment, general fatigue was the most highly affected dimension. CONCLUSIONS The results of this study show that quality of life is poor and fatigue measures are considerably increased in our young adult and pediatric patients with PIDs. These findings can indicate areas requiring more intensive interventions, and they will serve as a basis for comparison of future results.
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Affiliation(s)
- Saida Ridao-Manonellas
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Anna Fábregas-Bofill
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Gloria Núñez-Rueda
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Míriam González-Amores
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Marina García-Prat
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Laura López-Seguer
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Jacques G Rivière
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Andrea Martín-Nalda
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Natalia Mendoza-Palomar
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Susana Melendo-Pérez
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain
| | - Pere Soler-Palacín
- Paediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Infantil Vall d'Hebron (HIVH), Jeffrey Modell Foundation Excellence Centre, ERN RITA Centre, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Catalonia, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
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Bansal RA, Tadros S, Bansal AS. The presence of overlapping quality of life symptoms in primary antibody deficiency (PAD) and chronic fatigue syndrome (CFS). Allergy Asthma Clin Immunol 2020; 16:21. [PMID: 32256619 PMCID: PMC7106611 DOI: 10.1186/s13223-020-0417-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/04/2020] [Indexed: 01/26/2023] Open
Abstract
Background Fatigue, sleep disturbance and altered mood are frequently reported in patients with primary antibody deficiency syndrome (PADS) on adequate immunoglobulin replacement therapy. This study aimed to determine the frequency of symptoms compatible with chronic fatigue syndrome (CFS) in patients with PADS. Methods The study involved the distribution of 682 self-completed postal questionnaires to ascertain the presence and frequency of symptoms compatible with CFS in patients with PADS. The reporting of symptoms for each patient were scored against the CFS diagnostic criteria used within our own South London Chronic Fatigue service. Results The frequency of symptoms compatible with CFS were evident in 26 of the 188 patients (16.25%) returning adequately completed questionnaires. We considered a bias in the return of questionnaires amongst PADS patients with fatigue to be likely. As such we estimated the minimum frequency of CFS in patients with PADS to be 4% based on the 682 PAD patients to whom the questionnaire was distributed. This was significantly higher than the 0.5% estimate of the prevalence of CFS in the community in western populations. While the presence of significant fatigue correlated with the presence of anxiety and depression, there was no association with self-reported lung damage. Sleep disturbance affected 60% of the PAD patients returning satisfactory questionnaires and as expected the CFS score was higher in those with greater physical limitation. Conclusions We conclude that patients with PADS have a high frequency of fatigue, low mood and anxiety. We suggest routine questioning for the symptoms of fatigue, disturbed sleep and altered mood in patients with PADS. The use of several treatment strategies in CFS may prove beneficial in improving the quality of life of patients with PAD.
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Affiliation(s)
- Rhea A Bansal
- Frimley Health NHS Trust, Portsmouth Road, Camberley, Surrey GU16 7UJ UK
| | - Susan Tadros
- 2The Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK
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Supporting caregivers during hematopoietic cell transplantation for children with primary immunodeficiency disorders. J Allergy Clin Immunol 2018; 143:2271-2278. [PMID: 31178019 DOI: 10.1016/j.jaci.2018.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/23/2018] [Accepted: 10/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Caregivers of children with primary immunodeficiency disorders (PIDs) experience significant psychological distress during their child's hematopoietic cell transplantation (HCT) process. OBJECTIVES This study aims to understand caregiver challenges and identify areas for health care system-level improvements to enhance caregiver well-being. METHODS In this mixed-methods study caregivers of children with PIDs were contacted in August to November 2017 through online and electronic mailing lists of rare disease consortiums and foundations. Caregivers were invited to participate in an online survey assessing sociodemographic variables, the child's medical characteristics, psychosocial support use, and the World Health Organization-5 Well-Being Index. Open-ended questions about health care system improvements were included. Descriptive statistics and linear multivariate regression analyses were conducted. A modified content analysis method was used to code responses and identify emergent themes. RESULTS Among the 80 caregiver respondents, caregivers had a median age of 34 years (range, 23-62 years) and were predominantly female, white, and married with male children given a diagnosis of severe combined immune deficiency. In the adjusted regression model lower caregiver well-being was significantly associated with lower household income and medical complications. Challenges during HCT include maintaining relationships with partners and the child's healthy sibling or siblings, managing self-care, and coping with feelings of uncertainty. Caregivers suggested several organizational-level solutions to enhance psychosocial support, including respite services, online connections to other PID caregivers, and bedside mental health services. CONCLUSIONS Certain high-risk subpopulations of caregivers might need more targeted psychosocial support to reduce the long-term effect of the HCT experience on their well-being. Caregivers suggested several organizational-level solutions for provision of this support.
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Psychosocial services for primary immunodeficiency disorder families during hematopoietic cell transplantation: A descriptive study. Palliat Support Care 2018; 17:409-414. [PMID: 30223912 DOI: 10.1017/s1478951518000603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Caregivers for patients undergoing hematopoietic cell transplantation (HCT) are susceptible to significant psychosocial distress. This cross-sectional study aimed to describe psychosocial support services offered and used by caregivers of pediatric primary immune deficiency (PID) during HCT at 35 hospitals across North America. METHOD Caregivers of pediatric patients with PID were recruited by e-mail to participate in an anonymous 140-question survey instrument between April and May 2016 (N = 171). RESULT Of those meeting inclusion criteria (53%), family counseling services were only offered to fewer than half of caregivers (42%). Of the survey participants not offered counseling services, the majority desired family counseling (70%) and sibling counseling (73%). That said, when offered counseling, utilization rates were low, with 22% of caregivers using family counseling and none using sibling counseling. SIGNIFICANCE OF RESULTS These results indicate the need to offer and tailor counseling services for families throughout the HCT process. Further research should focus on reducing barriers to utilization of counseling services such as offering bedside counseling services, online modalities, and/or financial assistance.
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Advances and highlights in primary immunodeficiencies in 2017. J Allergy Clin Immunol 2018; 142:1041-1051. [PMID: 30170128 DOI: 10.1016/j.jaci.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/18/2018] [Accepted: 08/22/2018] [Indexed: 12/30/2022]
Abstract
This manuscript reviews selected topics in primary immunodeficiency diseases (PIDDs) published in 2017. These include (1) the role of follicular T cells in the differentiation of B cells and development of optimal antibody responses; (2) impaired nuclear factor κB subunit 1 signaling in the pathogenesis of common variable immunodeficiency, revealing an association between impaired B-cell maturation and development of inflammatory conditions; (3) autoimmune and inflammatory manifestations in patients with PIDDs in T- and B-cell deficiencies, as well as in neutrophil disorders; (4) newly described gene defects causing PIDDs, including exostosin-like 3 (EXTL3), TNF-α-induced protein 3 (TNFAIP3 [A20]), actin-related protein 2/3 complex-subunit 1B (ARPC1B), v-Rel avian reticuloendotheliosis viral oncogene homolog A (RELA), hypoxia upregulated 1 (HYOU1), BTB domain and CNC homolog 2 (BACH2), CD70, and CD55; (5) use of rapamycin and the phosphoinositide 3-kinase inhibitor leniolisib to reduce autoimmunity and regulate B-cell function in the activated phosphoinositide 3-kinase δ syndrome; (6) improved outcomes in hematopoietic stem cell transplantation for severe combined immunodeficiency (SCID) in the last decade, with an overall 2-year survival of 90% in part caused by early diagnosis through implementation of universal newborn screening; (7) demonstration of the efficacy of lentiviral vector-mediated gene therapy for patients with adenosine deaminase-deficient SCID; (8) the promise of gene editing for PIDDs using CRISPR/Cas9 and zinc finger nuclease technology for SCID and chronic granulomatous disease; and (9) the efficacy of thymus transplantation in Europe, although associated with an unexpected high incidence of autoimmunity. The remarkable progress in the understanding and management of PIDDs reflects the current interest in this area and continues to improve the care of immunodeficient patients.
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