How intravenous immunoglobulin is used in clinical practice: audits of two Sydney teaching hospitals

Lin, Marisa; Kirkpatrick, Philippa; Riminton, D. Sean

doi:10.1111/j.1445-5994.2007.01336.x

Cited by 22 publications

(37 citation statements)

References 3 publications

(7 reference statements)

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“…Contrary to their statements, our data from two Sydney teaching hospitals effectively challenge the perception that total IVIg use in Australia is accurately described by category 1 indications of the AHMAC 2000 guidelines 1 …”

Section: Replycontrasting

confidence: 98%

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Riminton

Lin

Kirkpatrick³

2007

Internal Medicine Journal

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Section: Replycontrasting

confidence: 98%

“…Our i.v. immunoglobulin (IVIg) audit findings led us to conclude that IVIg is approved and distributed by complex procedures that exist in the context of rapid changes in clinical practice 1 . Australian Red Cross Blood Service (ARCBS) representatives Dennington et al have confirmed these findings.…”

Section: Replymentioning

confidence: 98%

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Riminton

Lin

Kirkpatrick³

2007

Internal Medicine Journal

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“…The IVIg have been used in different specialties, and two of them (internal medicine and neurology) have included 75.1% of the patients (79.0% of the total IVIg quantity). In this study, nearly the half of the IVIg have been used in internal medicine specialty, whereas this clinical specialty was little (5.6%) or not reported in other studies [1,6,10]. It may be explained by the fact that haematologic pathologies (as primary or secondary immune deficiency and PTI) are cared in internal medicine specialty in our hospitals, whereas they can be cared in other medical units in other countries.…”

Section: Discussionmentioning

confidence: 60%

“…Nevertheless, it was more often for unlabelled indications [7–9]. This increase in IVIg use is linked to different difficulties such as the lack of resource with the risk of shortage and its high cost [1,10,11]. This growth has conducted some countries to review the IVIg use and to publish guidelines [1,6,12–14].…”

Section: Introductionmentioning

confidence: 99%

Use of intravenous immunoglobulins in clinical practice: data from three French university hospitals

Frauger¹,

Grassi²,

Pradel³

et al. 2011

Fundamental &Amp; Clinical Pharmacology

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Since several years, the use of intravenous immunoglobulins (IVIg) has increased. This growth has encouraged some countries to publish guidelines. In parallel, some countries have conducted audits to know how IVIg are used in clinical practice in the light of the available guidelines. The objective of this study was to assess IVIg use in three French university hospitals in 2006. All IVIg administrations were evaluated during 6 months (12 September 2005-12 March 2006) in French university hospitals of Marseille. Different data were recorded for each administration: patient characteristics, indication, formulation and quantity. During the study period, 2802 administrations of IVIg (corresponding to a total quantity of 76 780 g) have been recorded. Four hundred and thirty-five patients received at least one of these administrations. The five most reported indications were multifocal motor neuropathy (11.0% of total quantity), chronic inflammatory demyelinating polyradiculoneuropathy (10.2%), corticoresistant dermatomyositis (10.2%), immune thrombocytopaenia (9.9%) and primary immune deficiency (9.1%). According to available French recommendations, 70% of the IVIg use was for 'acknowledged indications', 9% for 'indications to be assessed' and 18% for 'unwarranted indications'. The 10 most reported indications were 'acknowledged indications' according to available recommendations of the French expert group. Nevertheless, the two most reported indications were not approved by the French Health Products Agency (AFSSAPS) at the time of the study and were approved since.

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“…Off label use of IVIG happens worldwide, an audit of IVIG use revealed a greater than expected proportion of non-category 1 IVIG use 9 . The ICU is a challenging setting as interventions may be life saving whereas the critically ill patients may be prone to develop complications.…”

Section: Discussionmentioning

confidence: 99%

Pattern of intravenous immunoglobulins (IVIG) use in a pediatric intensive care facility in a resource limited setting

Galal¹

2013

Afr H. Sci.

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Background: Intravenous Immunoglobulin (IVIG) preparations are scarce biological products used for replacement or immunomodulatory effects. Guidelines have been issued by regulatory health authorities to ensure provision of the products for patients who are in severe need. Objectives: The study aimed at description of the pattern of IVIG use (label/off label indications), adverse effects observed, reason for choice of IVIG among other modalities and efficacy in a pediatric intensive care setting. Methods: A retrospective chart review. Patients: The study included 45 cases admitted from 2008 through 2011 in a Pediatric Intensive Care Unit (PICU) of a tertiary referral pediatric hospital. Results: The clinical diagnoses included neurology (35%), neonatology (16%), hematology (11%), autoimmune disorders (11%) immunodeficiency disorders (11%), infections other than neonatal sepsis (9%) and cardiology (6.5 %). The indications for IVIG use had an Evidence category Ia / Ib in 62 % of cases whereas the other 38 % had level II and III evidence. Choice of IVIG as a therapeutic option was based on failure of other treatment options to achieve response in 46.5%, lack of alternative treatment options 15.5 % and the need for urgent response in 38 %. Adverse events, duration and doses are reported. Conclusion: IVIG use is governed by availability of alternative options and the need for urgent response in critically ill children. Guidelines should be issued based on locally available treatment options and their cost effectiveness.

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How intravenous immunoglobulin is used in clinical practice: audits of two Sydney teaching hospitals

Abstract: These audits emphasize the requirement for updated National Clinical Practice Guidelines, improved approval procedures, consensus statements in the specialties of immunology, haematology and neurology and clarification of the role of drug committees.

Cited by 22 publications

References 3 publications

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Use of intravenous immunoglobulins in clinical practice: data from three French university hospitals

Pattern of intravenous immunoglobulins (IVIG) use in a pediatric intensive care facility in a resource limited setting

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