The use of intravenous immunoglobulin therapy in a tertiary pediatric hospital

Abstract

Objectives: To determine demographic features of patients provided intravenous immunoglobulin (IVIG) excluding replacement therapy in the inpatient services and to evaluate indications for IVIG, and side effects related to therapy. Methods: Patients who received IVIG therapy between January 2016 and August 2018 were retrospectively identified. The demographic features, diagnosis, IVIG dose, number of days they underwent IVIG therapy, and whether or not they experienced IVIG-related side effects were recorded. Results: A total of 186 patients were included in this study, and of these, 89 (47.8%) were females. The median age of all of the patients was 48.5 months old (range 13-120 months). When the IVIG indications Original Article were examined, the hematological disease group had the highest number of patients (n=73, 39.2%). The US Food and Drug Administration (FDA) labeled use rate was 45.7%. Side effects were seen in 15 (3.81%) of the 394 IVIG infusions, 2 of which were acute kidney failure and nausea/vomiting as delayed onset side effects. The rapid onset side effects included fever (n=5), headache (n=3), rash and redness (n=2), and pain in the infusion area, hypotension, and hypertension (n=1). Conclusion: Intravenous immunoglobulin preparations are used for the treatment of many diseases due to their immunoregulatory effects. In recent years, the use of IVIGs without FDA approval has been increasing.

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

“…Moreover, these infusion-related reactions have been significantly reduced in the past 2 decades due to the improved manufacturing processes ( Wood et al, 2007 ) and refined administration protocol ( Aghamohammadi et al, 2004 ). In the literature, the reported rates of adverse drug reactions differed between studies and ranged from 3.8 to 6.1% of total administrations ( Toh et al, 2014 ; Güngör and Yarali, 2020 ). In this study, no adverse drug reactions were documented in the medical records.…”

Adverse Reactions Associated with Intravenous Immunoglobulin Administration in the Treatment of Neurological Disorders: A Systematic Review

“…Hypotension was reported in 10 of the included articles and appeared to be reported frequently in paediatric cohorts [8, 10, 11, 13, 15, 16, 20, 21, 23, 39]. In a paediatric inpatient cohort of 115 patients, hypotension was the most frequent AR in 28.7% (all indications of IVIg) [16].…”

“…Local injection site discomfort was reported in seven of the included studies [7, 13, 20, 22, 24, 25, 36]. Intravenous site discomfort was reported in 14 (33%) of neurological patients in one study [7] and in 4.6% of paediatric neuroimmunological patients in another study [20].…”

“…While premedication is used fairly commonly in routine practice, the use of corticosteroid premedication is rarely reported. Use of premedication strategies was reported most often in studies with paediatric cohorts [9, 13, 59]. One retrospective cohort study ( n = 186) recently reported the use of antipyretics and antihistamines in all patients to reduce ARs; ARs were reported in 15 (3.8%) of a total of 394 IVIg doses [13].…”

Table1.DOCX

“…Moreover, these infusionrelated reactions have been significantly reduced in the past 2 decades due to the improved manufacturing processes (Wood et al, 2007) and refined administration protocol (Aghamohammadi et al, 2004). In the literature, the reported rates of adverse drug reactions differed between studies and ranged from 3.8 to 6.1% of total administrations (Toh et al, 2014;Güngör and Yarali, 2020). In this study, no adverse drug reactions were documented in the medical records.…”