AUTHOR=Moral Moral Pedro , Garcia-Bustos Victor , Balastegui-Martin Héctor , Martínez Mercader Sandra , Bracke Carmen , Mateu Lourdes , Solanich Xavier , Antolí Arnau , Carrillo-Linares Juan Luis , Robles-Marhuenda Ángel , Puchades Francesc , Pelaez Ballesta Ana , López-Osle Nuria , Torralba-Cabeza Miguel Ángel , Bielsa Masdeu Ana María , Gil Niño Jorge , Tornador Gaya Nuria , Pascual Castellanos Guillem , Sánchez-Martínez Rosario , Barragán-Casas José Manuel , González-García Andrés , Patier de la Peña José Luís , López-Wolf Daniel , Mora Rufete Antonia , Canovas Mora Alba , Cabañero-Navalon Marta Dafne 

TITLE=Real-world patterns of immunoglobulin replacement therapy for infection prevention in common variable immunodeficiency: a multicenter nationwide study

JOURNAL=Frontiers in Immunology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2025.1640290

DOI=10.3389/fimmu.2025.1640290

ISSN=1664-3224

ABSTRACT=Background and aimsImmunoglobulin replacement therapy (IgRT), administered intravenously (IVIg) or subcutaneously (SCIg), is the cornerstone treatment for patients with Common Variable Immunodeficiency (CVID). Although both modalities demonstrate similar efficacy, SCIg is associated with fewer systemic adverse events and increased patient autonomy. Despite these advantages, its utilization remains limited in certain regions, particularly in the Mediterranean region. This study aimed to evaluate real-world patterns of IgRT use in Spanish CVID patients and provide a comprehensive analysis of the factors associated with IVIg and SCIg administration in routine clinical practice.MethodsA cross-sectional, multicenter study was conducted using data from the GTEM-SEMI-CVID Registry, encompassing 212 adult CVID patients receiving IgRT across Spain. Patients were grouped based on the administration route: IVIg and SCIg. Demographic, clinical, and immunological data, including IgRT modality, dosage, administration setting, and comorbidities, were collected. Comparative statistical analyses were performed to identify differences between both treatment groups.ResultsOf the 212 patients, 58.5% received IVIg and 41.5% received SCIg. SCIg recipients were younger (47.5 vs. 54.8 years, p = 0.003) and predominantly treated at home (80.6% vs. 1.6%, p < 0.001), compared to those receiving IVIg. SCIg use was significantly higher in tertiary hospitals compared to secondary ones (44.4% vs. 17.4%, p = 0.0136). Infection rates, autoimmune comorbidities, weekly doses (7.2 g for IVIg vs. 7.7 g for SCIg, p = 0.142), and IgG trough levels were comparable across groups.ConclusionThis study provides real-world evidence on IgRT patterns in Spanish patients with CVID, revealing a marked increase in SCIg use over the past decade, although IVIg remains predominant, especially in secondary hospitals. Age significantly influenced the choice of modality, with IVIg preferred for older patients and SCIg for younger ones, while disease severity did not impact this decision. These findings underscore the need to optimize access to SCIg, particularly in secondary centers, to enhance patient autonomy and improve therapeutic outcomes.