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A Systematic Review and Meta-regression Analysis on the Impact of Increasing IgG Trough Level on Infection Rates in Primary Immunodeficiency Patients on Intravenous IgG Therapy.
Journal of Clinical Immunology ( IF 7.2 ) Pub Date : 2020-05-16 , DOI: 10.1007/s10875-020-00788-5
Jian Lynn Lee 1 , Noraida Mohamed Shah 1 , Mohd Makmor-Bakry 1 , Farida Hanim Islahudin 1 , Hamidah Alias 2 , Lokman Mohd Noh 3 , Shamin Mohd Saffian 1
Affiliation  

PURPOSE We conducted a systematic review and meta-regression analysis to evaluate the impact of increasing immunoglobulin G (IgG) trough levels on the clinical outcomes in patients with PID receiving intravenous immunoglobulin G (IVIG) treatment. METHODS Systematic search was conducted in PubMed and Cochrane. Other relevant articles were searched by reviewing the references of the reviewed article. All clinical trials with documented IgG trough levels and clinical outcome of interest in patients receiving IVIG treatment were eligible to be included in this review. Meta-regression analysis was conducted using Comprehensive Meta-analysis Software. Additional sensitivity analyses were undertaken to evaluate the robustness of the overall results. RESULTS Twenty-eight clinical studies with 1218 patients reported from year 2001 to 2018 were included. The mean IVIG dose used ranges from 387 to 560 mg/kg every 3 to 4 weekly, and mean IgG trough obtained ranges from 660 to 1280 mg/dL. Random-effects meta-regression slope shows that IgG trough level increases significantly by 73 mg/dL with every increase of 100 mg/kg dose of IVIG (p < 0.05). Overall infection rates reduced significantly by 13% with every increment of 100 mg/dL of IgG trough up to 960 mg/dL (p < 0.05). CONCLUSION This meta-analysis concludes that titrating the IgG trough levels up to 960 mg/dL progressively reduces the rate of infections, and there is less additional benefit beyond that. Further studies to validate this result are required before it can be used in clinical practice.

中文翻译:

关于增加 IgG 谷水平对静脉 IgG 治疗原发性免疫缺陷患者感染率影响的系统评价和 Meta 回归分析。

目的 我们进行了系统评价和荟萃回归分析,以评估增加免疫球蛋白 G (IgG) 谷水平对接受静脉注射免疫球蛋白 G (IVIG) 治疗的 PID 患者临床结果的影响。方法 在 PubMed 和 Cochrane 中进行系统检索。其他相关文章通过查阅被审查文章的参考文献进行检索。所有在接受 IVIG 治疗的患者中记录了 IgG 谷值水平和感兴趣的临床结果的临床试验都有资格纳入本综述。使用综合元分析软件进行元回归分析。进行了额外的敏感性分析以评估整体结果的稳健性。结果 纳入了 2001 年至 2018 年报告的 1218 名患者的 28 项临床研究。使用的平均 IVIG 剂量范围为每 3 至 4 周一次 387 至 560 mg/kg,获得的平均 IgG 谷值范围为 660 至 1280 mg/dL。随机效应元回归斜率显示,随着 IVIG 剂量每增加 100 mg/kg,IgG 谷水平显着增加 73 mg/dL(p < 0.05)。随着 IgG 谷值每增加 100 mg/dL,总感染率显着降低 13%,直至 960 mg/dL (p < 0.05)。结论 该荟萃分析得出的结论是,将 IgG 谷水平滴定至 960 mg/dL 可逐渐降低感染率,除此之外,其他益处较少。在将其用于临床实践之前,需要进一步研究以验证该结果。随机效应元回归斜率显示,随着 IVIG 剂量每增加 100 mg/kg,IgG 谷水平显着增加 73 mg/dL(p < 0.05)。总体感染率显着降低 13%,每增加 100 mg/dL 的 IgG 波谷至 960 mg/dL (p < 0.05)。结论 该荟萃分析得出的结论是,将 IgG 谷水平滴定至 960 mg/dL 可逐渐降低感染率,除此之外,其他益处较少。在将其用于临床实践之前,需要进一步研究以验证该结果。随机效应元回归斜率显示,随着 IVIG 剂量每增加 100 mg/kg,IgG 谷水平显着增加 73 mg/dL(p < 0.05)。随着 IgG 谷值每增加 100 mg/dL,总感染率显着降低 13%,直至 960 mg/dL (p < 0.05)。结论 该荟萃分析得出的结论是,将 IgG 谷水平滴定至 960 mg/dL 可逐渐降低感染率,除此之外,其他益处较少。在将其用于临床实践之前,需要进一步研究以验证该结果。05)。结论 该荟萃分析得出的结论是,将 IgG 谷水平滴定至 960 mg/dL 可逐渐降低感染率,除此之外,其他益处较少。在将其用于临床实践之前,需要进一步研究以验证该结果。05)。结论 该荟萃分析得出的结论是,将 IgG 谷水平滴定至 960 mg/dL 可逐渐降低感染率,除此之外,其他益处较少。在将其用于临床实践之前,需要进一步研究以验证该结果。
更新日期:2020-05-16
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