Background and importance Intravenous immunoglobulin (IVIg) is a blood derived medicinal product prescribed for a range of medical conditions. Clinical evidence strongly supports the use of IVIg as firstline therapy in three neurological disorders; chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain–Barré syndrome (GBS) and multifocal motor neuropathy. There are an increasing number of other neurological conditions where IVIg is used despite limited evidence based data. Careful consideration of the efficacy of IVIg in each indication is required as it is a limited resource associated with high costs and potential supply shortages.
Aim and objectives To review the clinical indications for IVIg use in neurology patients at the Mater Misericordiae University Hospital (MMUH) and to compare prescribing practices to international evidence based guidelines.
Material and methods All neurology patients treated with IVIg between 2016 and 2018 were retrospectively reviewed using patient medical notes and pharmacy functionalities at the MMUH. Data collected included indication, dose prescribed, total number of IVIg courses, use of alternative therapies before IVIg and documentation of clinical benefit. Results were compared with international evidence based guidelines and verified by a neurology consultant.
Results 67 patients were included in the study. IVIg was prescribed for 15 indications. The most common were GBS, myasthenia gravis and CIDP. 31 patients received IVIg for licensed indications, whereas 36 patients received IVIg for unlicensed indications. The level of evidence from international evidence based guidelines supported the use of IVIg for most indications.
Conclusion and relevance This study demonstrated that IVIg was prescribed for a variety of neurological conditions at the MMUH, the majority of which were unlicensed. IVIg use was supported for most indications compared with international evidence based guidelines. However, IVIg was prescribed for several indications despite limited evidence of efficacy. This study highlights the need for evidence based clinical practice guidelines for IVIg use at the MMUH and Ireland.
References and/or acknowledgements
Perez EE, et al. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol 2017.
Updated Commissioning Criteria for the use of therapeutic immunoglobulin in immunology, haematology, neurology and infectious diseases in England January 2019. Department of Health 2019.
National Blood Authority of Australia. Criteria for the clinical use of intravenous immunoglobulins in Australia. October 2019.
Conflict of interest No conflict of interest