Which Immunoglobulin Route Best Prevents Infections?

Medscape

5 hours ago

TOPLINE:
In patients with inborn errors of immunity who are prone to viral infections, immunoglobulin replacement therapy (IRT) administered via the conventional subcutaneous route showed lower viral infection rates than the intravenous and facilitated subcutaneous routes.
METHODOLOGY:
Researchers conducted a cross-sectional study to compare the incidence of viral infections among immunocompromised patients who had been receiving IRT via different administration routes for more than 5 years.
They included 58 patients (56.8% boys; median age, 17 years; median age at diagnosis, 11.5 years) with inborn errors of immunity.
The intravenous route was the most common route of immunoglobulin administration (n = 32), followed by the conventional subcutaneous (n = 16) and facilitated subcutaneous (n = 10) routes.
Patients underwent monitoring of immunoglobulin levels and had nasal swab collected monthly, with viral infections recorded when symptoms such as runny nose, cough, or fever were present.
Infections from different immunoglobulin administration routes were analyzed by polymerase chain reaction testing of nasal swabs and serum immunoglobulin levels using nephelometry.
TAKEAWAY:
The overall viral infection frequency was 3.79%, with rates of 4.2% for the intravenous route, 2.5% for the conventional subcutaneous route, and 4.4% for the facilitated subcutaneous route of immunoglobulin administration.
The conventional subcutaneous route associated with significantly lower infection rates than the other routes (P < .05).
Adenovirus (21.8%), influenza A virus (16.4%), and human rhinovirus/enterovirus (16.4%) were the most frequently detected viral agents.
At 3 months, patients with X-linked agammaglobulinemia (6.06%) and those with common variable immunodeficiency (3.65%) had the highest rates of viral infections.
IN PRACTICE:
'Shared decision-making between patients and healthcare professionals is critical in determining the most appropriate administration route and product to minimize the risk of infections and achieve optimal treatment outcomes,' the authors wrote.
SOURCE:
The study was led by Hulya Kose, Department of Pediatric Immunology and Rheumatology, Uludağ University Faculty of Medicine, Bursa, Turkey. It was published online on May 30, 2025, in the European Journal of Pediatrics.
LIMITATIONS:
This research had limitations due to the small sample size within specific patient subgroups.
DISCLOSURES:
The study did not receive any specific funding. The authors declared having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.