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Subcutaneous Immunoglobulin Therapy for Chronic Inflammatory Demyelinating Polyneuropathy

A Nursing Perspective

Watkins, Jennifer M.; Dimachkie, Mazen M.; Riley, Patty; Murphy, Elyse

doi: 10.1097/JNN.0000000000000451
Pharmacology Update: PDF Only
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ABSTRACT Chronic inflammatory demyelinating polyneuropathy (CIDP), an immune-mediated peripheral neuropathy, is frequently treated with long-term maintenance intravenous immunoglobulin (IVIG). However, disadvantages of IVIG are the systemic adverse reactions, lengthy infusions, and need for vascular access. Subcutaneous immunoglobulin (SCIG) addresses many of the issues encountered by those unable, or unwilling, to tolerate the treatment burden of long-term IVIG. Subcutaneous immunoglobulin, a 20% solution stabilized with L-proline, is US Food and Drug Administration–approved for CIDP maintenance therapy in patients after being stabilized with IVIG. Approval was based on a randomized, double-blind, placebo-controlled trial where SCIG demonstrated superiority over placebo and was safe and efficacious in maintaining function. In addition to reviewing the primary efficacy results from the clinical trial, this article aims to update the neurology nursing community on a new option for long-term management of CIDP, including the practicalities of initiating and maintaining patients on SCIG therapy.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Questions or comments about this article may be directed to Jennifer M. Watkins, MSN APRN AGAC-NP, at watkins.jenni@gmail.com. She is a Nurse Practitioner, Neuromuscular Medicine, University of Kansas Medical Center, Kansas City, KS.

Mazen M. Dimachkie, MD FAAN FANA, is Professor of Neurology and Director of the Neuromuscular Division, University of Kansas Medical Center, Kansas City, KS.

Patty Riley, RN BAN CRNI, is Executive Medical Science Liaison, Immunoglobulins, Medical Affairs, CSL Behring, King of Prussia, PA.

Elyse Murphy, BSN RN, is Associate Director, Medical Field Team, Immunoglobulins, Medical Affairs, CSL Behring, King of Prussia, PA.

J.M.W. has received honoraria from CSL Behring for advisory board attendance. M.M.D. is on the speaker’s bureau or is a consultant for Shire, Catalyst, CSL Behring, Mallinckrodt, Novartis, and NuFactor. He has received grants from Alexion, Biomarin, Catalyst, CSL Behring, US Food and Drug Administration/Orphan Products Development, GlaxoSmithKline MDA, NIH, Novartis, Orphazyme, and The Myositis Association. P.R. and E.M. are employees of CSL Behring. Editorial support was provided by Meridian HealthComms Ltd funded by CSL Behring.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jnnonline.com).

© 2019 American Association of Neuroscience Nurses