Health-Related Quality of Life Unchanged in Long-Term IVIG for Common Variable Immunodeficiency

   Health-related quality of life (HRQOL) is maintained, without deterioration, over a long-term follow-up period of 11 years, during long-term immunoglobulin replacement therapy in patients with common variable immunodeficiency (CVID). That was the finding of a study the results of which were presented at the annual meeting of the American Academy of Allergy, Asthma and Immunology in New Orleans.

   Researchers from Case Western Reserve University in Cleveland and Oregon Health & Science University in Portland had previously reported that patients with CVID have a significantly worse HRQOL than patients with other chronic conditions. However, it was unknown how HRQOL might change in such patients while on long-term IV immunoglobulin (IVIG) replacement therapy.

   They administered the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a standardized method of assessing HRQOL, in 2009 to 12 adults with CVID receiving IVIG therapy who had also completed the survey in 1998. The changes in eight HRQOL dimensions (scored on a scale of 0 to 100) were compared with multiple linear regression with adjustments for demographic and clinical variables.

   Following data analysis, the research team found no significant change in any of the eight HRQOL dimension scores from 1998 to 2009. The maximum measured change for any dimension score was 2.7 points (P=0.214), and 11.6, (P=0.226) for the unadjusted and adjusted analyses, respectively.

   "Although patients with CVID have a worse HRQOL compared to individuals with other chronic illnesses, HRQOL is maintained, without deterioration," the researchers concluded.

   Also at the meeting, Salima Thobani, MD, a resident at the University of Southern California / Los Angeles County Medical Center, and colleagues reported on what they said was the first known case of a CVID patient with anaphylaxis to intravenous and subcutaneous immunoglobulin. A 23-year-old male who was first diagnosed with CVID at age 16 developed anaphylaxis following administration of 10 cc of IVIG. A switch to subclinical levels of IVIG was unsuccessful, as was later administration of subcutaneous immunoglobulin (SCIG) following admission with pneumonia and sepsis. Small escalation doses of SCIG (total dose 0.6cc) resulted within 30 minutes in anaphylaxis lasting 72 hours. The patient required intubation, epinephrine, norepinephrine drip, and steroids, and currently is at home on levaquin and clindamycin.

   "We are currently in discussions with experts world-wide for treatment options for this patient and plan to fully report the outcomes of this case," the USC physicians noted.