BRIEF RESEARCH REPORT article
Front. Immunol.
Sec. Primary Immunodeficiencies
Do CVID patients on SCIG have more autoimmune (thrombo)cytopenic events than CVID patients on IVIG?
Provisionally accepted
Nadezhda Camacho-Ordonez1Aleksandra Hirsch2Luiza Campos3,4
Sigune Goldacker2
Siobhan Oisin Burns3,4Fernando Moreira3
Klaus Warnatz1,2
Bodo Grimbacher1,2,5,6,7*- 1Institute for Immunodeficiency, Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
- 2Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
- 3Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
- 4University College London Institute of Immunity and Transplantation, London, United Kingdom
- 5Center for Integrative Biological signaling Studies (CIBSS), University of Freiburg, Freiburg, Germany
- 6Resolving Infection Susceptibility (RESIST) - Cluster of Excellence 2155 to Hannover Medical School, Satellite Center Freiburg, Freiburg, Germany
- 7German Center for Infection Research (DZFI), Satellite Center Freiburg, Freiburg, Germany
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Autoimmune thrombocytopenia (AITP) is frequent in patients diagnosed with common variable immunodeficiency (CVID). High dose intravenous immunoglobulin treatment (IVIG) has conventionally been a cornerstone of the initial therapy for AITP. This study aimed to assess the safety and effectiveness of subcutaneous immunoglobulin (SCIG) compared to IVIG in preventing AITP in CVID patients. This prospective observational study enrolled 47 adult CVID patients concurrently diagnosed with AITP. Of the participants, 27 (57%) were treated with SCIG, while 20 (43%) received IVIG. AITP episodes were defined as platelet counts <50,000/µl with bleeding or <20,000/µl with or without bleeding, followed over a 64-month period. Among the 47 patients included, 12 (25.5%) experienced AITP episodes, with seven using SCIG and five using IVIG. No significant difference was observed in AITP occurrence between the two treatment groups (p-value=0.99). Neither splenomegaly nor the use of immunosuppressive therapies showed a correlation to the AITP bouts. Maintaining IgG trough levels above 7g/l arose as a key factor for preventing AITP in both treatment modalities. In conclusion, both SCIG and IVIG demonstrated comparable efficacy in the prevention of AITP in CVID patients. This study highlights the importance of monitoring IgG levels in the management of CVID patients with AITP.
Keywords: Autoimmune thrombocytopenia, intravenous or subcutaneous immunoglobulin, Common Variable Immunodeficiency, Autoimmunity, Cytopenia
Received: 19 Sep 2025; Accepted: 12 Nov 2025.
Copyright: © 2025 Camacho-Ordonez, Hirsch, Campos, Goldacker, Burns, Moreira, Warnatz and Grimbacher. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bodo Grimbacher, bodo.grimbacher@uniklinik-freiburg.de
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