Background Human normal immunoglobulins (HNIg) have multiple indications such as replacement therapy or as immunomodulatory therapy for several autoimmune disorders. The use of HNIg in cancer patients is controversial, especially in children. Since HNIg represents a high cost and is a limited resource, it is necessary to evaluate their use basing it on evidence of medicine indications.
Purpose To optimise HNIg prescriptions of cancer patients in a paediatric teaching hospital, to achieve better efficiency of treatments.
Material and methods In a Day Case Unit (DCU) in a 262-bed paediatric teaching hospital, a multidisciplinary adequacy programme (MAP) of HNIg prescription was implemented. The team members were: two pharmacists and seven subspecialist paediatricians, one oncologist, two haematologists, two immunologists and two infectious disease doctors.
A treatment algorithm was elaborated to harmonise the HNIg prescription criteria. Patients’ prescriptions were verified and discussed monthly according to the criteria, reducing potentially inappropriate HNIg prescriptions and/or optimising their duration or dose.
The use of HNIg was compared with the first year before MAP implementation.
Results Fifty-eight out of the 117 patients treated with HNIg in the day care unit, were patients with a cancer baseline disease (19 oncologic and 39 haematologic).
Following the multidisciplinary adequacy criteria, we reviewed 14 old and 44 new prescriptions, checking their indication, dosing and treatment length.
Comparing the HNIg use between 1 year before the MAP was implemented and the first year after its implementation, both drug use and DCU appointments decreased (by 47% and 27%, respectively).
Only one treatment had to be reintroduced after its discontinuation.
Conclusion A MAP to optimise HNIg prescriptions was successfully implemented and improved efficiency in paediatric cancer patients. Since it allowed deprescription and/or reduction in treatment duration, both the drug use and, in consequence, the risk of adverse events decreased.
Other MAP can be stablished in other healthcare areas to control prescriptions in order to harmonise the criteria for treating the patients.
References and/or Acknowledgements Acknowledgements to all HNIg MAP collaborators.
No conflict of interest
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