Immunoglobulin Replacement Therapy Versus Antibiotic Prophylaxis as Treatment for Incomplete Primary Antibody Deficiency

Bas M. Smits, Ilona Kleine Budde, Esther de Vries, Ineke J. M. ten Berge, Robbert G. M. Bredius, Marcel van Deuren, Jaap T. van Dissel, Pauline M. Ellerbroek, Michiel van der Flier, P. Martin van Hagen, Chris Nieuwhof, Bram Rutgers, Lieke E. A. M. Sanders, Anna Simon, Taco W. Kuijpers, Joris M. van Montfrans*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background Patients with an IgG subclass deficiency (IgSD) +/- specific polysaccharide antibody deficiency (SPAD) often present with recurrent infections. Previous retrospective studies have shown that prophylactic antibiotics (PA) and immunoglobulin replacement therapy (IRT) can both be effective in preventing these infections; however, this has not been confirmed in a prospective study. Objective To compare the efficacy of PA and IRT in a randomized crossover trial. Methods A total of 64 patients (55 adults and 9 children) were randomized (2:2) between two treatment arms. Treatment arm A began with 12 months of PA, and treatment arm B began with 12 months of IRT. After a 3-month bridging period with cotrimoxazole, the treatment was switched to 12 months of IRT and PA, respectively. The efficacy (measured by the incidence of infections) and proportion of related adverse events in the two arms were compared. Results The overall efficacy of the two regimens did not differ (p = 0.58, two-sided Wilcoxon signed-rank test). A smaller proportion of patients suffered a related adverse event while using PA (26.8% vs. 60.3%, p <0.0003, chi-squared test). Patients with persistent infections while using PA suffered fewer infections per year after switching to IRT (2.63 vs. 0.64, p <0.01). Conclusion We found comparable efficacy of IRT and PA in patients with IgSD +/- SPAD. Patients with persistent infections during treatment with PA had less infections after switching to IRT. Clinical Implication Given the costs and associated side-effects of IRT, it should be reserved for patients with persistent infections despite treatment with PA.

Original languageEnglish
Pages (from-to)382-392
Number of pages11
JournalJournal of Clinical Immunology
Issue number2
Early online date18 Nov 2020
Publication statusPublished - Feb 2021


  • Primary immunodeficiency
  • primary antibody deficiency
  • SPAD
  • IgSD
  • prophylactic antibiotics
  • immunoglobulin replacement therapy
  • IRT
  • randomized controlled trial
  • RCT


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