In-depth interviews of patients with primary immunodeficiency who have experienced pump and rapid push subcutaneous infusions of immunoglobulins reveal new insights on their preference and expectations.

PURPOSE: Patients with primary immunodeficiency (PID) often receive immunoglobulin replacement therapy (IgRT). Physicians and patients have the choice between various methods of administration. For subcutaneous immunoglobulin infusions, patients may use an automated pump (P) or push the plunger of a syringe (rapid push [RP]). P infusions are performed once a week and last around 1 hour. RP decreases the duration of administration, but requires more frequent infusions. PATIENTS AND METHODS: Eight out of 30 patients (coming from a single center) who had participated in the cross-over, randomized, open-label trial comparing P and RP participated in a focus group or underwent in-depth interviews. Patients had a long history of home-based subcutaneous immunoglobulin using P. The trial suggested that RP had slightly greater interference on daily life than P, but similar efficacy and better cost-effectiveness. When asked about the delivery method they had preferred, around one-third of patients pointed out RP rather than P. In-depth interviews may reveal unforeseen reasons for patients' preferences. RESULTS: Interviews underlined the complexity of the relationship that the patients maintain with their disease and IgRT. Even if they recognized the genetic nature of the disease and claimed PID was a part of them, patients tried not to be overwhelmed by the disease. IgRT by P was well integrated in patients' routine. By contrast, RP too frequently reminded the patients of their disease. In addition, some patients pointed out the difficulty of pushing the plunger due to the viscosity of the product. Coming back too frequently, RP was not perceived as time saving over a week. Long-lasting use of P could partly explain patients' reasonable reluctance to change to RP. CONCLUSION: In-depth interviews of PID patients highlighted unforeseen reasons for patients' preference that the physician needs to explore during the shared medical decision-making process.

A cohort of French pediatric patients with primary immunodeficiencies: are patient preferences regarding replacement immunotherapy fulfilled in real-life conditions?

OBJECTIVE: To assess quality of life and satisfaction regarding immunoglobulin-replacement therapy (IgRT) treatment according to the route (intravenous Ig [IVIg] or subcutaneous Ig [SCIg]) and place of administration (home-based IgRT or hospital-based IgRT). SUBJECTS AND METHODS: Children 5-15 years old treated for primary immunodeficiency disease (PIDD) with IgRT for ≥3 months were included in a prospective, noninterventional cohort study and followed over 12 months. Quality of life was assessed with the Child Health Questionnaire - parent form (CHQ-PF)-50 questionnaire. Satisfaction with IgRT was measured with a three-dimensional scale (Life Quality Index [LQI] with three components: factor I [FI], treatment interference; FII, therapy-related problems; FIII, therapy settings). RESULTS: A total of 44 children (9.7±3.2 years old) receiving IgRT for a mean of 5.6±4.5 years (median 4.1 years) entered the study: 18 (40.9%) were receiving hospital-based IVIg, two (4.6%) were receiving home-based IVIg, and 24 (54.6%) were treated by home-based SCIg. LQI FIII was higher for home-based SCIg than for hospital-based IVIg (P=0.0003), but there was no difference for LQI FI or LQI FII. LQI FIII significantly improved in five patients who switched from IVIg to SCIg during the follow-up when compared to patients who pursued the same regimen (either IVIg or SCIg). No difference was found on CHQ-PF50 subscales, LQI FI, or LQI FII. CONCLUSION: Home-based SCIg gave higher satisfaction regarding therapy settings than hospital-based IVIg. No difference was found on other subscales of the LQI or CHQ-PF50 between hospital-based IVIG and home-based SCIG.

Abnormal cellular reactivity to microbial antigens in patients with uveitis.

PURPOSE: The purpose of the present study was to evaluate the cellular response to microbial antigens in patients with idiopathic uveitis. METHODS: Blood lymphocytes from 31 patients with uveitis and 24 healthy controls were cultivated with microbial antigens and analyzed by flow cytometry after staining with monoclonal antibodies against CD3, CD4, and activation markers CD69 and CD25. RESULTS: Although no difference was noted in circulating lymphocytes, the activation of T cells, detected with CD69, was higher in 24-hour blood culture from uveitis patients with Candida albicans antigen (Ca-Ag) than from controls, especially in posterior uveitis and panuveitis. Moreover, late response, detected with CD25, to different microbial antigens was higher in patient with uveitis. CONCLUSIONS: Such results suggest the role of Ca-Ag and microbial antigens in the pathogenic mechanisms of idiopathic uveitis.

Systemic T cell response to Toxoplasma gondii antigen in patients with ocular toxoplasmosis.

PURPOSE: Analysis of systemic cellular response to Toxoplasma antigen in patients with ocular toxoplasmosis. METHODS: Activated (CD25(+)) T cells were detected by flow cytometry after a 7-day culture of whole blood from patients with ocular (n = 16) or asymptomatic (n = 14) toxoplasmosis, and controls (n = 10), in the presence of soluble Toxoplasma antigen (ST-Ag). Interferon (IFN)-gamma, interleukin (IL) 4, and IL-10 were measured in culture supernatants by enzyme-linked immunosorbent assay. RESULTS: Higher percentages of CD25(+) T cells were detected in ST-Ag-activated cultures from Toxoplasma-infected patients, with or without ocular lesions (37.0 +/- 19.1% or 41.1 +/- 19.3%, respectively) than from controls (3.2 +/- 1.2%) (P < 0.0001). Differences were not statistically significant between asymptomatic and ocular toxoplasmosis (P > 0.4) or among congenital, acquired, and undetermined ocular toxoplasmosis (P > 0.2). Higher levels of IFN-gamma were detected in ST-Ag-stimulated blood cultures from infected patients than in those from controls (P < 0.0001), with no difference between patients with asymptomatic or ocular toxoplasmosis (P > 0.05). IL-10 was detected only in activated culture supernatants from three patients with ocular toxoplasmosis and two patients with asymptomatic toxoplasmosis. IL-4 was never produced in ST-Ag-activated cultures. CONCLUSIONS: Systemic cellular response to ST-Ag does not differ between the patients with ocular and asymptomatic toxoplasmosis with regard to activation markers and type 1 cytokine production.