Therapeutic immunoglobulin should be dosed by clinical outcome rather than by body weight in obese patients

Clinical and Experimental Immunology
J P HodkinsonHelen M Chapel

Abstract

There are currently no data to support the suggestion that the dose of therapeutic immunoglobulin (Ig) should be capped in obese patients for pharmacokinetic (PK), safety and economic reasons. We compared IgG trough levels, increment and efficiency in matched pairs of obese and lean patients receiving either replacement or immunomodulatory immunoglobulin therapy. Thirty-one obese patients were matched with a clinically equivalent lean patient across a range of indications, including primary antibody deficiency or autoimmune peripheral neuropathy. Comprehensive matching was carried out using ongoing research databases at two centres in which the dose of Ig was based on clinical outcome, whether infection prevention or documented clinical neurological stability. The IgG trough or steady state levels, IgG increments and Ig efficiencies at times of clinical stability were compared between the obese and lean cohorts and within the matched pairs. This study shows that, at a population level, obese patients achieved a higher trough and increment (but not efficiency) for a given weight-adjusted dose compared with the lean patients. However at an individual patient level there were significant exceptions to this correlation, and upon su...Continue Reading

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Citations

Aug 8, 2015·The Journal of Allergy and Clinical Immunology. in Practice·Mary LucasHelen Chapel
Mar 7, 2017·Clinical and Experimental Immunology·J P Hodkinson
May 10, 2017·Clinical and Experimental Immunology·J P Hodkinson, H Chapel
Nov 2, 2017·Journal of the Peripheral Nervous System : JPNS·Krista KuitwaardPieter A van Doorn
Jul 26, 2018·Current Opinion in Neurology·Pietro E Doneddu, Eduardo Nobile-Orazio
Dec 12, 2017·Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology·Rohan Ameratunga
Aug 28, 2020·The International Journal of Neuroscience·Mahima Kapoor Carr
Apr 27, 2017·Einstein·Ekaterini Simões GoudourisWilma Carvalho Neves Forte
May 8, 2021·International Immunopharmacology·Jian Lynn LeeShamin Mohd Saffian

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