Real-world Observations on the Use of Immunoglobulin Therapy in Patients With Multifocal Motor Neuropathy in a Home Infusion Setting
Timothy Walton1, Elizabeth Neal1, Carol Sauerbrun1, Elizabeth Duruz1, Jordan Bruns1, James Sheets1, Randy Broyles1, Leslie Myers1, Michele Way1, Edward O'Bryan1
1CSI Pharmacy
Objective:

To evaluate Immunoglobulin (Ig) therapy monitoring and clinical outcomes in Multifocal Motor Neuropathy (MMN) patients receiving home infusion therapy.

Background:
MMN is a rare, progressive neurological disorder, primarily causing limb muscle weakness, without sensory impairment or pain. It’s often misdiagnosed due to similarities with Amyotrophic Lateral Sclerosis.  Intravenous Ig (IVIg) is FDA approved for MMN to improve muscle strength and disability, while Subcutaneous Ig (SCIg) serves as an alternative.  Home infusion providers play a critical role in payor approvals of Ig therapies in MMN and managing clinical outcomes.
Design/Methods:

As part of the Clinical Outcomes 360°® program, a multidisciplinary team implemented a monitoring program in MMN. A retrospective review was conducted from April 2016 to August 2025, including active patients. The Rasch-built Overall Disability Scale for MMN (MMN-RODS©) was used to assess disability. Data included demographics, dosing patterns, Adverse Drug Reactions (ADRs), and outcomes, collected through pharmacist-led interviews and nursing documentation. Descriptive analyses summarized findings.

Results:

Thirty-seven patients were reviewed, where 91.9% received IVIg and 8.1% SCIg. Median age was 66 and 51.4% male. Median IVIg dosing was 1.06g/kg every four weeks and SCIg 1.08g/kg/month (0.27g/kg/weekly) with 737 Ig dispenses filled (618 IVIg/119 SCIg). Most patients (92%) reported some level of muscle weakness throughout treatment. Twenty-five patients completed a total of 45 MMN-RODS©, with median scores ranging from 37 to 48. ADRs were mostly mild or moderate, including headache, hypertension, anemia, nausea, and site reactions of swelling, itching, and redness. One serious ADR (elevated serum creatinine) was reported.

Conclusions:

Home infusion providers play a critical role in MMN care through therapy oversight and safety monitoring. IVIg remains the primary treatment, with SCIg a viable alternative. While MMN-RODS© offers valuable insight, inconsistent symptom reporting limits tracking. Future research should focus on improved outcome measures, such as grip strength, and enhanced patient engagement to optimize therapy.

10.1212/WNL.0000000000216291
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