4CPS-129 Evaluation of the real infusion time of intravenous immunoglobulin and influential factors in routine clinical practice analysis

Abstract

BackgroundIntravenous immunoglobulin (IVIG) is the standard of care for humoral immunodeficiencies (HID) and several systemic autoimmune diseases. Its chronic administration represents an important economic and logistical impact.PurposeTo assess the real time of infusion of IVIG compared to the established maximums and to analyse which factors could affect it, in order to find out if the infusion rate could be higher.Material and methodsAn observational, ambispective study with patients chronically receiving IVIG was conducted at the day hospital of a tertiary hospital (December 2016 to March 2017).Biodemographic data (sex, age, weight) and clinical data (primary diagnosis, dose, frequency of administration) were obtained from medical records. Infusion and premedication times were collected from the nursing management software (Gacela®)The primary endpoint was infusion time expressed as mean and standard deviation (SD) for each commercial preparation. The influence of demographic covariates, IVIg dose, commercial preparation and the need and type of premedication was also analysed (ANOVA test was performed with Stata®).ResultsOne hundred and seventy-five patients were included (51% females, mean age of 55 (20–91)). Sixty-nine patients had HID, 89 had neurological disease and 17 had systemic autoimmune diseases.The dose administered, need of premedication and commercial preparation had an impact on the time of infusion. However, it was not affected by sex, weight or age.Logically at higher doses, more infusion time was required. Moreover, the infusion rate was higher in the case of Intratec® (9.14 g/h, SD 0.98 g/h, n=3), Octagamocta® (8.48 g/h, SD 1.81 g/h, n=25) and Privigen® (8.39 g/h, SD 2.30 g/h, n=84). Flebogamma-Plangamma5%® (7.33 g/h, SD 1.76 g/h, n=36) and Flebogamma10%® (7.61 g/h, SD 1.54 g/h, n=16) achieved intermediate velocities. The preparations with the lowest IVIg infusion rate values were Kiovig® (7.30 g/h, SD 2.60 g/h, n=6) and Gammagard® (644 g/h, SD 2.08 g/h, n=5).All preparations were infused at a lower rate (p<0. 05) than the maximum set in the technical sheet.Premedication was necessary in 72 patients (41%) oral acetaminophen being the most commonly used. However, premedication combinations were also effective (31 patients, 18%) with acetaminophen +dexchlorpheniramine (11 patients) the most used.ConclusionAdministration of IVIG is performed at an infusion rate that is below the established maximums. Despite this fact, many patients need premedication to avoid infusion reactions. In the light of the results, increasing the rate of IVIG administration should be considered for those patients with good tolerance, saving time and money invested in day hospitals.References and/or AcknowledgementsThanks to all authors for their involvementNo conflict of interest