A Safer Immunoglobulin: Subcutaneous Route Shows Promise for High-Risk Patients
A large retrospective study published in the Journal of Neurology, Neurosurgery & Psychiatry provides new insights into the thromboembolic risk of immunoglobulin therapies for neuroinflammatory diseases. The analysis of 243 patients over 15 years compared intravenous immunoglobulin (IVIg) with subcutaneous immunoglobulin (SCIg). While the overall incidence of thromboembolic events (TEEs) was low, the rate was numerically higher with IVIg (1.38 events per 100 patient-years) than with SCIg (0.52 events per 100 patient-years), though this difference was not statistically significant. Crucially, the study found that while a patient’s baseline vascular risk score (QRISK3) correlated with TEE likelihood, some younger patients on IVIg with low QRISK3 scores still experienced events, suggesting IVIg itself may independently increase risk. In contrast, TEEs on SCIg occurred only in patients with high pre-existing vascular risk.
Why it might matter to you: For nephrologists managing complex patients with autoimmune conditions or post-transplant immunosuppression, this comparative safety data is highly relevant. It suggests that SCIg may be a preferable option for patients with chronic kidney disease or end-stage renal disease who already carry a significant burden of vascular risk factors, potentially offering a safer immunomodulatory strategy. This evidence can directly inform risk-benefit discussions and therapeutic choices in a vulnerable patient population.
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