Routine blood monitoring in maintenance immunoglobulin treatment of inflammatory neuropathy: Is it clinically relevant?

JOURNAL OF THE NEUROLOGICAL SCIENCES

卷:408

Article

Keh, R.¹  Kahlil, A.²  Nihoyannopoulos, L.²  Compton, L.²  Kapoor, M.²  Gosal, D.¹  Manji, H.²  Rossor, A. M.²  Reilly, M. M.^2,3  Lunn, M. P.²  Lavin, T. M.¹  Carr, A. S.² 

[1] Salford Royal Hosp, Manchester Ctr Clin Neurosci, Salford, Lancs, England

[2] Natl Hosp Neurol & Neurosurg, Ctr Neuromuscular Dis, 8-11 Queens Sq, London, England

[3] Inst Neurol, MRC, Ctr Neuromuscular Dis, UCL Queen Sq, London, England

关键词: Inflammatory neuropathy;    CIDP;    MMN;    Intravenous immunoglobulin;    Drug safety;   

DOI  :  10.1016/j.jns.2019.116527

来源: Elsevier

【 摘 要 】

Background: Pre-treatment screening for IgA deficiency and close monitoring of full blood count(FBC) and renal function is recommended with intravenous immunoglobulin(IVIg) therapy in neurological diseases. Aims: To examine the frequency of biochemically defined and clinically significant episodes of treatment associated haemolysis, neutropenia, thrombocytopenia and acute kidney injury(AKI) in a cohort of patients on maintenance Immunoglobulin(Ig) therapy for inflammatory neuropathy. Methods: A retrospective review of routine blood monitoring in patients from two UK specialist peripheral nerve centres. Accepted definitions for clinically and biochemically significant haemolysis, neutropenia, thrombocytopenia and AKI were used. Results: 1919 infusion episodes in 90 patients were analysed. Age(mean(S.D)) = 58.09(14.4)years, 63% male, 72% CIDP(28% MMN), 97% IVIg(3% SCIg). Dose = 1.57(0.79)g/kg/month or 97.1(37.3)g/infusion, frequency:3.9(1.4) weeks. Relative IgA deficiency was noted in 2 individuals (prevalence:2.2%, 95%C.I.:0-5.2) who received a combined total of 38 infusions(3800 g IVIg) without adverse event. No clinically significant episodes of haemolysis, neutropenia, thrombocytopenia or AKI occurred in relation to treatment. An asymptomatic drop > 10 g/L haemoglobin(Hb) occurred in 3.5%(95%CI:2.7-4.3) of treatment episodes in 38 individuals, mean reduction:17.7(7.4)g/L; lowest Hb:86 g/L. Lower pre-treatment haemoglobin correlated with risk of recurrent Ig-related drop(p:0.007). Two patients with chronic renal failure(stage 1 and 3) received 28(IV) and 104(SC) infusions respectively(6416 g) without impact on estimated glomerular filtration rate(eGFR). Conclusions: No clinically significant Ig-related episodes of haemolysis or AKI were identified in this representative cohort. This suggests that routine monitoring is not essential in long-term Ig use but should be considered when clinically indicated.

【 授权许可】

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