Pneumococcal Antibody Levels in Children With PID Receiving Immunoglobulin

Author:

Tuerlinckx David1,Florkin Benoit2,Ferster Alina3,De Schutter Iris4,Chantrain Christophe56,Haerynck Filomeen7,Philippet Pierre6,Strengers Paul8,Laub Ruth9

Affiliation:

1. Department of Pediatrics, Université Catholique de Louvain, Centre Hospitalier Universitaire, Mont-Godinne, Yvoir, Belgium;

2. Department of Pediatrics, Université Libre de Liège, Centre Hospitalier Régional Citadelle, Liège, Belgium;

3. Pediatric Hematology Oncology, Hopital Universitaire Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium;

4. Department of Pediatrics, Pediatric Pulmonology, Cystic Fibrosis Clinic and Pediatric Infectious Diseases, Universitair Ziekenhuis Brussel, Brussels, Belgium;

5. Department of Pediatric Hematology Oncology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium;

6. Pediatric Hematology Oncology, Department of Pediatrics, Centre Hospitalier Chrétien—Clinique de L’Espérance, Liège, Belgium;

7. Department of Pediatric Pulmonology and Immunology, Ghent University Hospital, Gent, Belgium; and

8. Medical Department, and

9. Research and Development, Central Department for Fractionation of the Red Cross, Brussels, Belgium

Abstract

OBJECTIVES: Clinical data are lacking on optimal levels of specific antipneumococcal antibodies (PnPsAbs) in patients with primary immunodeficiency (PID) receiving intravenous immunoglobulin (IVIG) replacement. Objectives were to conduct a prospective multicenter study providing data on total immunoglobulin G (IgG) and peak/trough levels of PnPsAbs specifically targeting the 16 most prevalent pneumococcal serotypes in IVIG-treated children with PID; to compare trough PnPsAb levels with those measured in healthy adults and the IVIG product; and to evaluate PnPsAb protection correlates with thresholds based on World Health Organization. METHODS: Patients received 7 consecutive IVIG infusions. Total IgG and PnPsAb levels were determined on plasma samples obtained before and after infusion. RESULTS: Twenty-two children with PID were treated with IVIG (mean weekly dose: 0.10 g/kg). The mean trough and peak levels of total IgG were 7.77 and 13.93 g/L, respectively. Trough and peak geometric mean concentrations and distribution curves differed between serotypes and showed wide dispersion (0.17–7.96 µg/mL). In patients (89%–100%), antibodies against most serotypes reached trough levels ≥0.2 µg/mL, a threshold considered protective against invasive pneumococcal infection. For several serotypes, trough levels reached ≥1.0 to 1.3 µg/mL, the level found in adults. Trough geometric mean concentrations correlated well with the PnPsAb contents of the IVIG product. CONCLUSIONS: In IVIG-treated children with PID, protective PnPsAb levels for most pathogenic serotypes were obtained. A correlation was observed between PnPsAb levels in patients and in the IVIG product. This offers the potential to improve infection prevention by adapting the IVIG product and dose according to epidemiology.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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