{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T21:19:08Z","timestamp":1793999948811,"version":"4.8.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Immunoglobulin replacement therapy (IgRT), either intravenous (IVIg) or subcutaneous (SCIg), is crucial for managing primary immune deficiencies (PIDs) with hypogammaglobulinemia by reducing infection rates and mortality. During the COVID-19 pandemic, a global shortage of SCIg prompted our unit to reduce SCIg doses or maintain the same dose intravenously. This study evaluates the impact of a standardized SCIg dose reduction on infection rates and clinical outcomes in patients with humoral PID and with a low burden of infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult PID patients on SCIg for at least 6 months, with IgG trough levels \u2265 700 mg\/dL (or \u2265 900 mg\/dL under specific conditions), and no significant infections in the past 6 months were eligible. A dose reduction of 15 mg\/kg\/week (60 mg\/kg\/month) for every 150 mg\/dL above 700 mg\/dL (or 900 mg\/dL) was proposed. Clinical and laboratory data, and infectious events at 6- and 12-month follow-ups, were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-one patients with PID were included: common variable immunodeficiency (54.83%), IgG subclass deficiency (9.67%), and other PIDs (35.48%). The average SCIg dose was initially reduced from 7.82 g\/week to 5.72 g\/week and adjusted to 6.94 g\/week at 12 months. There was no significant change in severe or mild infections before and at 6- and 12-months post-dose adjustment. The dose reduction saved an average of 5,550 euros per patient annually, totaling 172,050 euros annually for our cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Optimizing SCIg doses in selected well-controlled humoral PIDs is feasible without increasing infection rates, conserving this plasma-derived product during shortages. Larger prospective studies are needed to confirm this strategy's utility and its application to other Ig formulations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2024.1527514","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:24:01Z","timestamp":1737332641000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Infectious outcomes of a standardized subcutaneous immunoglobulin dose reduction strategy in primary immune deficiencies amid global shortage"],"prefix":"10.3389","volume":"15","author":[{"given":"Pedro","family":"Moral Moral","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta Dafne","family":"Cabanero-Navalon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula Teresa","family":"L\u00f3pez-Le\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9ctor","family":"Balastegui-Mart\u00edn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Mart\u00ednez Mercader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amparo","family":"Mir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Garcia-Bustos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s12026-012-8318-2","article-title":"Human B cell defects in perspective","volume":"54","author":"Cunningham-Rundles","year":"2012","journal-title":"Immunol Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/j.1749-6632.2011.06206.x","article-title":"Ten warning signs of primary immunodeficiency: a new paradigm is needed for the 21st century","volume":"1238","author":"Arkwright","year":"2011","journal-title":"Ann N Y Acad Sci"},{"key":"B3","doi-asserted-by":"crossref","first-page":"376 p","DOI":"10.1007\/978-3-319-91785-6","volume-title":"Humoral primary immunodeficiencies (Rare diseases of the immune system","author":"D\u2019Elios","year":"2019"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.1033666","article-title":"Current clinical spectrum of common variable immunodeficiency in Spain: The multicentric nationwide GTEM-SEMI-CVID registry","volume":"13","author":"Caba\u00f1ero-Navalon","year":"2022","journal-title":"Front Immunol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-09-377945","article-title":"Morbidity and mortality in common variable immune deficiency over 4 decades","volume":"119","author":"Resnick","year":"2012","journal-title":"Blood"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2006.01.015","article-title":"Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology","volume":"117","author":"Orange","year":"2006","journal-title":"J Allergy Clin Immunol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.2007.03432.x","article-title":"Recognition, clinical diagnosis and management of patients with primary antibody deficiencies: a systematic review","volume":"149","author":"Wood","year":"2007","journal-title":"Clin Exp Immunol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-012-9720-1","article-title":"Home-based subcutaneous immunoglobulin versus hospital-based intravenous immunoglobulin in treatment of primary antibody deficiencies: systematic review and meta analysis","volume":"32","author":"Abolhassani","year":"2012","journal-title":"J Clin Immunol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2012.06.021","article-title":"Recombinant human hyaluronidase-facilitated subcutaneous infusion of human immunoglobulins for primary immunodeficiency","volume":"130","author":"Wasserman","year":"2012","journal-title":"J Allergy Clin Immunol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/s1567-5769(03)00134-6","article-title":"Comparison of the efficacy of IGIV-C, 10% (caprylate\/chromatography) and IGIV-SD, 10% as replacement therapy in primary immune deficiency. 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