Home IVIG for CIDP: A Focus on Patient Centred Care

Objective: To determine the safety and tolerability of home-based intravenous immunoglobulin (IVIG) (Gamunex) as maintenance treatment in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIdP) in Canada. Methods: We enrolled ten subjects with CIdP who had previously received IVIG in the hospital setting to receive the comparable IVIG dose (1-2 g/kg/month) in the home for six months. The patients were evaluated in the clinic at three months and at six months to evaluate their clinical status as well as the safety and tolerability of IVIG. Results: All subjects tolerated home-based IVIG treatment as maintenance treatment of CIdP. There were no serious adverse events related to IVIG. subjects did experience "anticipated" IVIG events postinfusion such as headache and fatigue, which were managed with analgesics and supportive counseling. One subject withdrew consent at end of study due to hospitalization. This event was not related to the IVIG. Another subject experienced a "flare" of CIdP symptoms near the end of the study, however, completed all visits as per protocol. All subjects expressed excellent satisfaction with the individualized therapy, and almost all (nine out of ten) patients preferred home-infusion to hospital-infusion. Conclusion: Intravenous immunoglobulin can be delivered safely and is well tolerated outside the hospital setting in Canada in patients with chronic, stable neuromuscular conditions such as CIdP who have previously tolerated IVIG in the hospital medical day Care Unit.