{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:52:34Z","timestamp":1761007954821,"version":"build-2065373602"},"reference-count":15,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2025,9,24]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Intravenous immunoglobulin (IVIg) is effective in many neuroinflammatory disorders but carries a risk of thromboembolic events (TEEs). Subcutaneous immunoglobulin (SCIg) is effective, but its thromboembolic risk profile is less well-described, particularly in patients with prominent vascular risk factors. We investigated the thromboembolic risk profile of IVIg and SCIg using a large single-centre retrospective dataset of patients with neuroinflammatory disorders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>243 patients treated with immunoglobulin over a 15-year monitoring period were analysed. Demographic information was used to calculate QRISK3 vascular risk scores. Patients were grouped based on having received IVIg-only, SCIg-only or both IVIg and SCIg (with subgroup analysis of IVIg and SCIg treatment periods). TEE incidence rates were compared. The relationship between QRISK3 and TEE likelihood was analysed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1401 patient-years immunoglobulin treatment data were obtained. The SCIg-only cohort was older with higher QRISK3 scores. More patients on IVIg (n=14) than SCIg (n=2) experienced TEEs on treatment (1.38 vs 0.52 events per 100 patient-years), but this difference was not statistically significant. IVIg-treated patients with TEEs were younger (p=0.039) than SCIg-treated TEE patients. QRISK3 scores broadly correlated with thromboembolic risk across the cohort (p=0.027), but some younger IVIg patients with low QRISK3 scores experienced TEEs indicating that IVIg but not SCIg independently increases thromboembolic risk. QRISK3 scores &gt;10% identified 71% and 100% of TEEs in IVIg-treated and SCIg-treated patients, respectively, but are insensitive (7%) as TEEs are rare events.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>SCIg is at least equivalent in thromboembolic risk to IVIg and may be safer for patients with existing vascular risk factors.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jnnp-2025-337097","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T17:20:30Z","timestamp":1760980830000},"page":"jnnp-2025-337097","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Thromboembolic risk of intravenous and subcutaneous immunoglobulin treatment for neuroinflammatory diseases"],"prefix":"10.1136","author":[{"given":"Tobias","family":"Rogers","sequence":"first","affiliation":[{"name":"Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura M","family":"White","sequence":"additional","affiliation":[{"name":"Lancaster University School of Health and Medicine, Lancaster, UK"},{"name":"Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Cooper","sequence":"additional","affiliation":[{"name":"Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Smith","sequence":"additional","affiliation":[{"name":"Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Gosal","sequence":"additional","affiliation":[{"name":"Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6434-9496","authenticated-orcid":false,"given":"Ryan Yann Shern","family":"Keh","sequence":"additional","affiliation":[{"name":"Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,20]]},"reference":[{"key":"2025102010201968000_jnnp-2025-337097v1.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1529-8027.2010.00290.x"},{"key":"2025102010201968000_jnnp-2025-337097v1.2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14959"},{"key":"2025102010201968000_jnnp-2025-337097v1.3","unstructured":"NHS England . Clinical commissioning policy for the use of therapeutic immunoglobulin (ig) england (2025). 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Available: https:\/\/qrisk.org\/ [Accessed 26 Jun 2025]."},{"key":"2025102010201968000_jnnp-2025-337097v1.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.j2099","article-title":"Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study","volume":"357","author":"Hippisley-Cox","year":"2017","journal-title":"BMJ"},{"key":"2025102010201968000_jnnp-2025-337097v1.10","first-page":"e635","article-title":"Thromboembolic risk with IVIg: Incidence and risk factors in patients with inflammatory neuropathy","volume":"94","author":"Kapoor","year":"2020","journal-title":"Neurology (ECronicon)"},{"key":"2025102010201968000_jnnp-2025-337097v1.11","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2022-328881"},{"key":"2025102010201968000_jnnp-2025-337097v1.12","unstructured":"National Institute for Health and Care Excellence . CVD risk assessment and management: scenario: management of people with an estimated risk of 10% or more. 2025 Available: https:\/\/cks.nice.org.uk\/topics\/cvd-risk-assessment-management\/management\/cvd-risk-10percent-or-more\/"},{"key":"2025102010201968000_jnnp-2025-337097v1.13","unstructured":"R: the r project for statistical computing. 2025. 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