Background The use of intravenous immunoglobulin (IVIg) may represent a therapeutic option with great economic impact in clinical situations where there might be other alternatives; it is therefore advisable to strictly follow the recommendations of available clinical guidelines.
Purpose To evaluate the use of IvIg and its adaptation to the licensed indications in a private hospital.
Material and methods A retrospective observational study was conducted from January 2014 to September 2016 of IvIg prescriptions. We reviewed medical records and analysed drug costs through the SAP management programme. To set the correct indication, product information from the AEMPS (Spanish Drugs Agency) website was revised and also the Immunoglobulin Clinical Guidelines for Use, 2nd Edition 2008, and 2nd Edition Update, 2011, from the British Department of Health. Statistical variables analysed were: prescribing service, indication, dose, age and drug cost.
Results During the study period, IVIg were used in 35 patients. Mean age was 44.3±29.47 years. Prescribing services were: neurology 48.6% of patients; haematology 20%; paediatrics 25.7%; and intensive care 5.7%. Among the indications that are approved in the technical specifications and/or recommended by the guidelines reviewed were: 25.7% of patients with Guillain–Barre syndrome, 14.3% Kawasaki disease, 8.57% secondary hypogammaglobulinaemia, 8.57% adult patients with idiopathic thrombocytopenic purpura (ITP), 5.7% children with ITP, 5.7% idiopathic demyelinating polyneuropathy chronic, 2.86% primary immunodeficiency patients, 2.86% myasthenia gravis and 2.86% multifocal motor polyneuropathy. Prescribing conditions based on weak evidence were, in most cases, rare diseases: 8.57% acute disseminated encephalomyelitis patients, 8.58% patients with other demyelinating diseases and 5.72% secondary thrombopenia. The prescribed doses were calculated based on the patient’s weight and the associated costs were approximately €177 814.
Conclusion Based on these results, IVIg have been prescribed in our hospital according to their license and/or recommended indications, except in some pathologies in which there are not enough evidence and where the prescribing doctor has studied each case and prioritised their use as the best care available. Although there are studies in which IVIg are prescribed on the ideal weight of patients as optimisation strategy and based on the drug pharmacokinetics, the latest edition of the British Guidelines shows that this recommendation has limited evidence.
No conflict of interest
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