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Abstract: PO1935

Use of Subcutaneous IgG to Treat Hypogammaglobinemia in ANCA-Associated Vasculitis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kant, Sam, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Azar, Antoine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Gapud, Eric J., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Geetha, Duvuru, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Background

Intravenous immunoglobulin (IVIG) has been used to treat ANCA vasculitis (AAV) patients with recurrent infections as a result of hypogammaglobinemia induced by treatment regimens such as rituximab. Subcutaneous immunoglobulin (SCIG) has a better safety and tolerability profile. We characterized the clinical features, treatment and outcomes of AAV patients treated with SCIG).

Methods

We conducted a retrospective chart analysis of 187 patients in our AAV database to identify patients with recurrent infections and hypogammaglobinemia subsequently treated with SCIG. Patient demographics, clinical characteristics, treatment and immunological parameters were assessed.

Results

Of the 187 patients identified with AAV,6 were treated with SCIG. All were Caucasian,PR3 positive and majority (n=4) were females.All patients had pulmonary involvement, and regimens of cyclophosphamide (CYC) and/or rituximab (RTX) were employed for induction and remission. Ig levels (IgG, IgM, IgA) were reduced in all patients.CD19/CD20 B cells were depleted, and CD3/4/8 and NK cells were preserved in all patients. The majority of patients(n=4) experienced recurrent URIs, 3 had shingles,in addition to other infections(table 1).All patients had no discernible IgG antibody response to pneumococcal vaccine.Mean duration between first rituximab administration and initiation of SCIG was 6.4 years. Four patients continued to receive RTX every 6 to 12 months while 2 patients remained in remission off RTX for over 2 yrs.IgG levels normalized and none of the patients had recurrence of infections after initiation of SCIG

Conclusion

These data, albeit preliminary, is one of the first series that demonstrates SCIG can be a safe and reliable alternative to IVIG in AAV patients with recurrent infections secondary to hypogammaglobinemia.Our data also suggest that SCIG may have immunomodulatory effects to maintain disease remission in AAV