Use of intravenous immunoglobulin in an <scp>A</scp>sian paediatric population over a 10‐year period

Wu, Jibin; Lee, Alison Joanne; Goh, Anne; Chia, Moira Suyin; Ho, Christopher; Bugarin, Jackelyn Laycano; Chan, Yiong‐Huak; Lee, Bee-Wah

doi:10.1111/jpc.12262

Cited by 6 publications

(6 citation statements)

References 16 publications

(30 reference statements)

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“…This value is much higher than those reported in the other studies. A study conducted in Singapore over a 10-year period in two public pediatric hospitals reported that IVIG was used for off-labeled indications in only less than 25% of cases (Wu et al, 2013). A study on IVIG use in the 10 institutions in Canada from 1997 to 1999 found that 38% of children received IVIG for offlabeled indications (Hanna et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Intravenous immunoglobulin therapy among pediatric patients: labeled and off-labeled indications

Toh

Islahudin

Ali

et al. 2018

Braz. J. Pharm. Sci.

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This study was designed to evaluate utilization patterns and clinical outcome of intravenous immunoglobulin (IVIG) therapy among pediatric patients in a tertiary hospital. Demographic data, IVIG prescribed, and clinical outcome were retrospectively reviewed from the pharmacy dispensing data and patient medical records between 2007 and 2014. One hundred and fifteen instances of IVIG administration to 108 pediatric patients were recorded. A total of 61 cases (53%) and 54 cases (47%) of the IVIG administered were for labeled and off-labeled indications, respectively. Age, weight, specialty, total IVIG usage, length of hospital stays, and mortality rate were found to be significantly associated with the indication being labeled or off-labeled (p<0.05). However, there was no significant difference in terms of adverse reactions between labeled and off-labeled indications (p>0.05). Guidelines should be developed and implemented for rational and evidence-based use of IVIG to avoid unnecessary wastage.

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Section: Discussionmentioning

confidence: 99%

Intravenous immunoglobulin therapy among pediatric patients: labeled and off-labeled indications

Toh

Islahudin

Ali

et al. 2018

Braz. J. Pharm. Sci.

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“…However, this value is much higher than those reported in the other studies. A study conducted in Singapore over a 10-year period in two public paediatric hospitals reported that IVIG was used for off-labelled indications in only less than 25.0% of cases, while in Qatar, only 22.7% of children received IVIG for off-labelled indications ( 18 , 19 ). These variations can result from a variety of causes, such as the incidence of disease in different countries, varying patient conditions, and so forth.…”

Section: Discussionmentioning

confidence: 99%

Practise of Immunoglobulin Replacement Therapy in Primary and Secondary Immunodeficiencies: A Single Centre Experience from Malaysia

Zahari¹,

Hamid²,

Din³

et al. 2023

MJMS

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Background: Intravenous immunoglobulin (IVIG) replacement therapy is increasingly in demand. This study focused on the characteristics of IVIG usage and associated factors toward the frequency status of IVIG among patients in Hospital Kuala Lumpur. Methods: A retrospective cross-sectional study was performed on patients who received IVIG in Hospital Kuala Lumpur. Data were extracted from the request forms for IVIG recorded in the Pharmacy Department from January 2018 until December 2019. Chi-squared test and t-test analysis were used for statistical analysis, and a P-value of < 0.05 was considered significant. Results: A total of 482 patients received IVIG in Hospital Kuala Lumpur. There were 243 (50.4%) females and 228 (47.3%) males with median age of the patients was 27 years old. The highest indications for IVIG among all patients were hypogammaglobulinemia and other deficiency states in 127 patients (26.3%). The most common indication for one-off treatment in adults was hypogammaglobulinemia and other deficiency states, 35%; whereas in paediatrics, it was Kawasaki disease, 20.3%. The highest indication for regular therapy among adult patients was chronic inflammatory demyelinating polyneuropathy (23.4%), while in paediatrics it was sepsis (31.1%). The clinical category was associated with the frequency status of IVIG usage in both adult and paediatric cohorts with P = 0.004 and P = 0.017, respectively. Conclusion: There were significant differences between the indication of one-off treatment and regular therapy among adult and paediatric patients. A national guideline on the prescription of IVIG for patients is instantly needed to help clinicians in prescribing IVIG appropriately.

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“…Similar prescribing pattern studies have been conducted in several countries and the prevalence of prescriptions with off-label indications of IVIG ranged from 22.7 to 70.3% ( Rezaie et al, 2019 ; Tonkovic and Rutishauser, 2014 ; Toh et al, 2014 ; Ruiz-Antorán et al, 2010 ; Constantine et al, 2007 ; Pendergrast et al, 2005 ; El Ajez et al, 2019 ) ( Supplementary Table S3 ). Likewise, the prevalence of patients being prescribed with IVIG for an off-label indication ranged from 23.2 to 81.5% ( Chen et al, 2000 ; Pendergrast et al, 2005 ; Dawoud et al, 2012 ; Wu et al, 2013 ; Fakhari et al, 2018 ; Rezaie et al, 2019 ). The wide range could be due to different categorization or interpretation of off-labels, study periods, or duration of data collection, as licensing of an indication may change over time with the availability of more studies supporting its use.…”

Section: Discussionmentioning

confidence: 99%

“…These results corroborate the findings by ( Fakhari et al, 2018 ), whereby older age patients were more likely to receive IVIG for an off-labeled indication. Noticeably, the studies of IVIG utilization conducted for pediatric usage were mostly for FDA-licensed indications ( Wu et al, 2013 ; Aydin and Tanır, 2017 ; El Ajez et al, 2019 ). It appears that IVIG is more likely to be tested out for new indications in adult diseases.…”

Section: Discussionmentioning

confidence: 99%

Prescribing Practices of Intravenous Immunoglobulin in Tertiary Care Hospitals in Malaysia: A Need for a National Guideline for Immunoglobulin Use

et al. 2022

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Rational use of drug involves the use of medicine as per clinical guidelines. Given the steady increase in the clinical utility of intravenous immunoglobulin (IVIG) either as licensed or off-label use, concerns are being raised about the possibility of supply shortages that could significantly impact patient care. Therefore, there is a need to regulate and to promote the rational use of this valuable medication. This cross-sectional chart review study attempts to evaluate the prescribing patterns of IVIG at two tertiary hospitals in Malaysia. Patients’ medical files and dispensing records were examined and compared with current guidelines. A total of 348 prescriptions for IVIG were written during the 1-year study period. The highest usage of IVIG was for neurological (47.9%), immunological (27.5%), and hematological conditions (20%). The number of prescriptions with the US Food and Drug Administration (FDA) licensed indications and off-label indications was 148 (42.5%) and 200 (57.5%), respectively. Age (OR: 1.02, 95% CI: 1.01–1.03, p = 0.003) and those admitted to the critical care units (OR: 11.11, 95% CI: 5.60–22.05, p < 0.001) were significant factors for receiving IVIG for an off-label indication. Most prescriptions (79%) had appropriate dosing. Significant factors associated with receiving inappropriate dose of IVIG include age (OR: 0.93, 95% CI: 0.89–0.97, p = 0.001) and those admitted to the critical care units (OR: 10.15, 95% CI: 3.81–27.06, p < 0.001). This study advocates the development and implementation of evidence-based clinical guidelines with prioritization protocol to ensure rational use of IVIG.

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Use of intravenous immunoglobulin in an Asian paediatric population over a 10‐year period

Abstract: Albeit substantial and increasing, the use of IVIG in Singaporean children is mostly evidence based.

Cited by 6 publications

References 16 publications

Intravenous immunoglobulin therapy among pediatric patients: labeled and off-labeled indications

Intravenous immunoglobulin therapy among pediatric patients: labeled and off-labeled indications

Practise of Immunoglobulin Replacement Therapy in Primary and Secondary Immunodeficiencies: A Single Centre Experience from Malaysia

Prescribing Practices of Intravenous Immunoglobulin in Tertiary Care Hospitals in Malaysia: A Need for a National Guideline for Immunoglobulin Use

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