Background and importance An enlargement of the number of indications for intravenous immunoglobulins (IVIg) in recent years has resulted in an increase in the consumption of these products. A lack of raw material has led to shortages of IVIg.1
Aim and objectives The objective of this work was to evaluate the impact of this situation on patient management in one French university centre, considering practice modifications and clinical outcomes.
Material and methods All patients treated with IVIg for chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, Guillain–Barré syndrome and myasthenia gravis were included, from October 2017 to October 2018. The analysis of practices was carried out between 2016 and 2019.
Results Of 155 patients, 72% had a modification of IVIg treatment, including 51% who had a delay in treatment, 28% a decrease in dose and 21% experienced an interruption in IVIg treatment. About 29% of patients for whom IVIg treatment was stopped were switched to other treatments, mainly plasma exchange. 58 patients presented one deterioration of their clinical score after prescription changes, including 31 patients who had a moderate or a clinically significant deterioration. For 17 patients, clinical deterioration was directly related to the IVIg shortage.
Concerning practice modifications, we noted a substantial but not significant decrease in the median dose for myasthenia gravis and a significant increase in the delay between treatments for chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy (p=0.011 and p=0.018).
Conclusion and relevance Our study showed a rather important number of IVIg prescription changes related to IVIG shortages during the study period. These changes had a negative impact on the clinical status of some patients. The interest of this study is essential because of the fragility of the post coronavirus disease period related to a lack of plasma from which blood products derive.
References and/or acknowledgements
Sewell WAC, Kerr J, Behr-Gross M-E, et al. European consensus proposal for immunoglobulin therapies. Eur J Immunol 2014;44:2207–14.
References and/or acknowledgementsThe authors thank the department of neuromuscular diseases and the pharmacy team for their help in collecting the data.
Conflict of interest No conflict of interest