Impact of trough IgG on pneumonia incidence in primary immunodeficiency: A meta-analysis of clinical studies

Primary immunodeficiency disease (PIDD) associated with hypogammaglobulinemia is typically treated with immunoglobulin replacement therapy. When administered as intravenous immunoglobulin (IVIG), an IgG trough occurs prior to the next replacement dose. While frequently measured, IgG trough levels re...

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Veröffentlicht in:	Clinical immunology (Orlando, Fla.) Jg. 137; H. 1; S. 21 - 30
Hauptverfasser:	Orange, Jordan S., Grossman, William J., Navickis, Roberta J., Wilkes, Mahlon M.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Amsterdam Elsevier Inc 01.10.2010 Elsevier
Schlagworte:	Adolescent Adult Agammaglobulinemia - complications Agammaglobulinemia - immunology Agammaglobulinemia - prevention & control Agammaglobulinemia - therapy Aged Allergy and Immunology Biological and medical sciences Child Child, Preschool Clinical Trials as Topic Common variable immunodeficiency Dose Female Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Hypogammaglobulinemia Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunoglobulin G - blood Immunoglobulin G - immunology Immunoglobulins, Intravenous - administration & dosage Immunoglobulins, Intravenous - blood Immunoglobulins, Intravenous - therapeutic use Immunologic Deficiency Syndromes - blood Immunologic Deficiency Syndromes - complications Immunologic Deficiency Syndromes - immunology Immunologic Deficiency Syndromes - therapy Immunopathology Incidence Infant Intravenous immunoglobulin IVIG Male Medical sciences Meta-analysis Middle Aged Pneumonia Pneumonia - complications Pneumonia - immunology Pneumonia - prevention & control Primary immunodeficiency Treatment Outcome Trough concentration X-linked agammaglobulinemia Young Adult Pneumonia Trough concentration Common variable immunodeficiency Intravenous immunoglobulin IVIG X-linked agammaglobulinemia Dose Incidence Primary immunodeficiency Meta-analysis Immunopathology Lung disease Immunoglobulins Intravenous administration Respiratory disease IgG X-tinked agammaglobutinemia Concentration Epidemiology Metaanalysis Immunology Immunoglobulinopathy Primary
ISSN:	1521-6616, 1521-7035, 1521-7035
Online-Zugang:	Volltext
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Zusammenfassung:	Primary immunodeficiency disease (PIDD) associated with hypogammaglobulinemia is typically treated with immunoglobulin replacement therapy. When administered as intravenous immunoglobulin (IVIG), an IgG trough occurs prior to the next replacement dose. While frequently measured, IgG trough levels required to minimize infection risk are not established. To address this question, all available studies evaluating trough IgG and pneumonia incidence in PIDD patients with hypogammaglobulinemia receiving IVIG were quantitatively combined by meta-analysis. Seventeen studies with 676 total patients and 2,127 patient-years of follow-up were included. Pneumonia incidence declined by 27% with each 100mg/dL increment in trough IgG (incidence rate ratio, 0.726; 95% confidence interval, 0.658–0.801). Pneumonia incidence with maintenance of 500mg/dL IgG trough levels (0.113 cases per patient-year) was 5-fold that with 1000mg/dL (0.023 cases per patient-year). This meta-analysis provides evidence that pneumonia risk can be progressively reduced by higher trough IgG levels up to at least 1000mg/dL.
Bibliographie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	1521-6616 1521-7035 1521-7035
DOI:	10.1016/j.clim.2010.06.012