Current usage of intravenous immune globulin and the rationale behind it: the Massachusetts General Hospital data and a review of the literature

Abstract

Only a few indications account for most of the usage for IVIG. Reports concerning IVIG continue to grow at a tremendous pace but few high-quality randomized controlled trials have been reported. Randomized trials are especially needed for conditions such as CIDP, which consume large quantities of product.

CD200-dependent and nonCD200-dependant pathways of NK cell suppression by human IVIG

“…Intravenous immunoglobulins (IVIGs) has licensed and 'off label' efficacy in suppressing a variety of immune inflammatory disorders [1]. There is also empirical evidence for benefit in patients with recurrent spontaneous abortion if secondary or associated with autoantibodies or elevated natural killer (NK)-lineage cells in blood [2][3][4].…”

Descriptive Review and Analysis of Immunoglobulin Utilization Management from 2,548 Prior Authorization Requests

“…Two key studies, similar to those from Canada, examined the patterns of IVIg use in hospital systems. Darabi et al (2006) evaluated the use of IVIg at Massachusetts General Hospital for calendar year 2004 in a study of 194 patients. 15 At the time of this study, IVIg required review against the hospital guidelines by a physician before it was authorized for patient use.…”

“…Darabi et al (2006) evaluated the use of IVIg at Massachusetts General Hospital for calendar year 2004 in a study of 194 patients. 15 At the time of this study, IVIg required review against the hospital guidelines by a physician before it was authorized for patient use. The authors did not define these guidelines or describe the occurrence or criteria by which IVIg was denied-variables that would be of comparative interest with our current findings.…”

Home Care Use of Intravenous and Subcutaneous Immunoglobulin for Primary Immunodeficiency in the United States

“…While human immunoglobulin (Ig) has been increasingly used for many disease states, antibody replacement in primary immune deficiency (PIDD) states was its first established use and still constitutes one of the main indications for this therapy [1][2][3]. The clinical benefits of Ig include decreased incidence of upper and lower respiratory tract bacterial infections, reduced antibiotic use, fewer hospital admissions, improved growth, maintenance of normal pulmonary functions, and improved quality of life [4,5].…”

“…However, there are still substantial differences in the amounts of Ig prescribed by individual practitioners, and it is important to understand the utilization of Ig in the treatment of PIDD in the United States. Most previous publications on the use of Ig have focused on global Ig use in hospital settings [1,[10][11][12]. As 45.1 % of all subjects with PIDD are likely to receive Ig treatment [13], and in most cases in the home, we examined the demographics, products, and dosing of Ig used in the home care setting for a large cohort of subjects with PIDD in the United States.…”