Background and importance Intravenous immunoglobulin (IVIG) is a blood product used for replacement therapy and immunomodulation in various conditions. Its use is usually restricted to situations with clinical benefit and established evidence, due to the drug’s production method and high economic value. Recently, the Portuguese National Pharmacy and Therapeutics Committee (NPTC) released guidance for a more evidence based IVIG use approach.¹

Aim and objectives To characterise the IVIG prescription profile in our institution; to assess if IVIG is prescribed and used in accordance with guidance No 8, May 2020, from NPTC and the National Medicines Formulary (NMF); and to evaluate the impact of IVIG consumption on the hospital’s financial budget.

Material and methods All IVIG prescriptions from January 2018 to May 2020 were analysed. Indications, doses, infusion rates (IR) and adverse reactions (AR) were registered in an Excel spreadsheet. The indications were classified as either on or off-label, regarding their inclusion in the aforementioned guidance and as per the NMF. The economic impact was calculated from the average price, using SGICM-GLINTT pharmacy software.

Results The study included 131 prescriptions, of which 92.4% conformed to the NMF: 60.3% were replacement therapy, 31.2% immunomodulation cases and the remaining 8.5% were off-label (of these, 64% had probable benefit). The most prevalent indications were chronic inflammatory demyelinating polyradiculopathy (39%) and MyD88 deficiency (31%). Doses and IR were as indicated. There were recorded AR. IVIG accounted for 1.21% of the institution’s total medication expenses.

Conclusion and relevance IVIG was mostly used for approved indications. Doses and IR were within the recommended range and no AR were reported, suggesting that the administrations was well tolerated. Off-label use, although characterised by limited expression and for indications with probable benefit, included indications not mentioned in the guidance. In this study, hospital prescriptions showed a low level of compliance with the NPTC guidance; therefore, an institutional protocol should be developed for a more evidence based approach to IVIG use. Locally, the annual expenses for IVIG (1.21%), a value way below the national average (2.83%), may be due to the smaller size and complexity of the hospital and slight off-label use.

References and/or acknowledgements

1. Comissão Nacional de Farmácia/Terapêutica. (2020). Recomendação sobre utilização de IgHN. Orientações Comissão Nacional Farmácia/Terapêutica.

Conflict of interest No conflict of interest