Considerations for dosing immunoglobulin in obese patients. (17th April 2017)

• Record Type: Journal Article
• Authors: Hodkinson, J. P.
• Other Names: Hodkinson John guestEditor.; Chapel Helen guestEditor.
• Is Part Of: Clinical and experimental immunology. Volume 188:Number 3(2017:Jun.)
• Page Start: 353
• Page End: 362
• Publication Date: 2017-04-17
• Subjects: dosing -- immunoglobulin -- IVIg -- obesity -- primary immunodeficiency; Immunopathology -- Periodicals; 616.079
• DOI: 10.1111/cei.12955
• Languages: English
• ISSNs: 0009-9104

Abstract

Summary: Obesity is a very common condition; however, the effect of excess body weight on the appropriate dose of immunoglobulin has not been defined empirically. The proposed pharmacokinetic differences between lean and obese patients and the opportunity to reduce costs has led to the proposition that obese patients should receive proportionally lower doses of immunoglobulin once a certain threshold is reached. Here the theoretical factors which could affect dosing in obese patients are considered alongside the available empirical evidence. The available evidence indicates that obesity may affect the pharmacokinetics of immunoglobulin; however, the effect is likely to be too small to have a clinically important effect on dosing. Wide interpatient individuality and highly variable clinical need mean that obesity should not play a major factor in dosing considerations. However, patients who are obese are more likely to have multiple cardiovascular risk factors and their weight indicates a large dose. This puts these patients at a higher risk of adverse reactions, and therefore caution is advised. Abstract : Dosing of immunoglobulin in obesity has become an area of debate due to considerations of cost, efficacy and safety. The literature indicates that many factors may affect the appropriate dose of immunoglobulin in obese patients and a balance of factors must be considered. The evidence indicates however that the practical impact of obesity on dosing is likely to be small.