By Ronale Tucker Rhodes, MS
Sometimes, it’s a good thing that history repeats itself — especially when it comes to medicine. This struck me as I was researching an article about how far modern medicine has come over the past several centuries and even the past several decades.
Indeed, many of you reading this blog may be interested to know the history of how immune globulin (IG) therapy has evolved to treat patients over the past 60 years. If anything, it could spark some hope for how treatment for immune and autoimmune diseases could evolve over the next few decades.
In my research, I discovered that it wasn’t until 1952 when the first patient presented with recurring infections that were attributed to the absence of gamma globulin and antibody activity. Doctors treated this 8-year-old patient with subcutaneous injections of gamma globulin at monthly intervals, which resulted in him being free of serious infection.
Not long after that, individuals with acquired forms of hypogammaglobulinemia and agammaglobulinemia also were identified. Most of these patients were treated with monthly injections of gamma globulin that were given intramuscularly (IM) because administration by the intravenous (IV) route was deemed unsafe due to adverse reactions. But, there were many patients who couldn’t tolerate IM injections because of the pain; so, instead, they were treated subcutaneously with slowly delivered immune serum globulin (ISG) with the use of a small syringe driver pump. This was the first use of subcutaneous IG (SCIG) therapy, although it was abandoned in favor of IVIG therapy once a safe IV preparation was identified in 1982.
The first patients successfully treated with high-dose IVIG were children diagnosed with idiopathic thrombocytopenic purpura (ITP). Then, in the 1980s, it was discovered that high-dose IVIG could successfully treat Kawasaki syndrome, which led to trials in many other inflammatory conditions of both autoimmune and uncertain etiology, including Guillain-Barré syndrome, myasthenia gravis, chronic idiopathic demyelinating polyneuropathy, polymyositis, dermatomyositis and stiff person syndrome. In 1995, an expert panel developed criteria for evaluating off-label (or non-FDA-approved) uses of IVIG.
Yet, despite how miraculous IVIG therapy has been in treating thousands of patients, many experience problems, including poor venous access or significant adverse side effects during or after treatment. Because of this, manufacturers went back to the research lab, and the first SCIG therapy was licensed in Germany in December 2002 and in the U.S. in January 2006. Today, there are four U.S. FDA-approved SCIG products on the market, which allow patients to infuse in the home setting at more frequent intervals that keep their serum IG trough levels at a more steady rate.
So, the question is: If IG therapy has progressed this far in as little as 60 years, what might happen in the next few decades? History might repeat itself with both improved and newly discovered products, different infusion methods and who knows what else. Maybe IG therapy won’t even be needed. What’s your prediction?