CP-009 Adequacy of intravenous immunoglobulin prescription at a teaching hospital

Abstract

Background Off-label prescription of intravenous immunoglobulin (IVIg) has long been widely accepted, but periodically, verification with the latest available evidence-based efficacy data is needed. Purpose To assess the suitability of the current prescription of IVIg at our hospital according to latest evidence-based efficacy data for possible interventions required. Materials and methods The research was based on the colour classification introduced by the British ‘Clinical guidelines for immunoglobulin use. 2nd edition. July 2011 update. Department of Health’ adapted for Spain by the Spanish Society of Hospital Pharmacy in 2012. For each patient who received IVIg at our hospital during the year 2012, indication and total grams received were recorded. Results In the year 2012, 20,917.8 g of IVIg were administered at our hospital to 77 patients for 16 different indications. 43.57% of the total was administered for highest priority indications. 33.73% was used for diseases for which there is a reasonable evidence base but where other treatment options are available. 22.70% was used to treat pathologies for which the evidence base was weak. There were no prescriptions for disrecommended indications. For each category, the annual grams per patient were 233.71, 243.28 and 527.56 g/patient respectively. The indication for which the highest doses were used (22.70%) was severe axonal neuropathy. Conclusions The bulk of the IVIg is being used at our hospital either for indications with a good or reasonable evidence base. Nevertheless, when it comes to grams prescribed per indication, severe axonal neuropathy, an indication not included in the aforementioned guide, proves to be the one with the highest rate. As remarked in the guide, indications not included shall be considered to have a weak evidence base; consequently IVIg treatment in severe axonal neuropathy should be closely monitored in each patient to weigh the benefits. No conflict of interest.