Effectiveness of low-dose intravenous immunoglobulin therapy in minor primary antibody deficiencies: A 2-year real-life experience

Primary antibody deficiencies (PAD) are the most prevalent group of primary immunodeficiencies (PID) in adults and immunoglobulin replacement therapy (IRT) is the mainstay therapy to improve clinical outcomes. IRT is, however, expensive and, in minor PAD, clear recommendations concerning IRT are lacking. We conducted a retrospective real-life study to assess the effectiveness of low-dose IRT in minor PAD on 143 patients fulfilling European Society for Immunodeficiencies (ESID) diagnostic criteria for immunoglobulin (Ig)G subclass deficiency (IgGSD) or unclassified antibody deficiency (UAD). All patients were treated with intravenous low-dose IRT (0.14 +/- 0.06 g/kg/month). Immunoglobulin (Ig) classes and IgG subclasses were measured at baseline and after 1 year of IRT. The annual rate of total infections, upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI) and hospitalizations was measured at baseline and after 1 and 2 years of IRT. After 1 year of IRT significant improvement was demonstrated in: (a) serum IgG (787.9 +/- 229.3 versus 929.1 +/- 206.7 mg/dl; p < 0.0001); (b) serum IgG subclasses (IgG1 = 351.4 +/- 109.9 versus 464.3 +/- 124.1, p versus 330.6 +/- 124.9, p versus 55.6 +/- 28.9 mg/dl, p < 0.002); (c) annual rate of total infections (5.75 +/- 3.87 versus 2.13 +/- 1.74, p < 0.0001), URTI (1.48 +/- 3.15 versus 0.69 +/- 1.27; p < 0.005), LRTI (3.89 +/- 3.52 versus 1.29 +/- 1.37; p < 0.0001) and hospitalizations (0.37 +/- 0.77 versus 0.15 +/- 0.5; p < 0.0002). The improvement persisted after 2 years of IRT. No significant improvement in URTI annual rate was noted in UAD and in patients with bronchiectasis. In conclusion, low-dose IRT can improve clinical outcomes in UAD and IgGSD patients, providing a potential economical advantage over the standard IRT dose.