Basic and clinical immunology – 3030. Subcutaneous immunoglobulin therapy: An option for patients who have experienced thrombotic complications with intravenous therapy
Bibliographic record
Abstract
This article was originally published online on 23 April 2013 We report the effective and safe use of subcutaneous immunoglobulin (SCIG) therapy in a patient who suffered stroke following replacement intravenous immunoglobulin (IVIG) infusions for common variable immune deficiency (CVID) at age 28 years. CVID is one of the 6 FDA-approved uses for IVIG, and is required lifelong in these patients. Systemic adverse reactions occur in approximately 2-6% of infusions 1, while thrombotic events are very rare. A Therapeutic dilemma arose when our patient had a stroke after an IVIG infusion. After the stroke, our patient’s IgG level fell to 1.17 g/L, resulting in recurrent pneumonia. Cautious doses of IVIG were restarted and the patient remained on warfarin. These were tolerated well for 13 years. With the introduction of higher concentrations of IgG available for subcutaneous administration, we transitioned the patient to SCIG since it offered many advantages. The preparation was tolerated well by the patient, resulted in therapeutic trough levels, and was effective at preventing infection. It is also associated with a lower risk of thrombotic complications including stroke theoretically since this is extremely rare, related to the even physiologic nature of serum IG levels, without marked increases in levels following the administration of the SCIG preparation 2. The patient was cautiously continued on IVIG therapy 7 months after the stroke, with modest doses initially of 20g in 250mL solution q4 weeks (goal trough IgG 5-7 g/L). This dose was effective and tolerated well and it was gradually titrated to higher trough levels 9 years later. With known and theoretical advantages of SCIG therapy, the patient achieved therapeutic trough IG level of 9.5 g/L, and did not have any further thrombotic events or other systemic reactions. The patient continues on q3-4-weekly SCIG infusions that are both safe and effective. This therapy may also offer significant Quality of life (QOL) advantages to the patients and their families. We report a CVID patient who had a cerebrovascular accident following an IVIG infusion. He was successfully restarted on IVIG therapy while on warfarin and then switched to SCIG, which he has tolerated well.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.061 | 0.028 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".