Non-specific intravenous immunoglobulins: Evaluation of use
Le résumé fourni par la source
Introduction: Non-specific immunoglobulin preparations (Ig) are blood products with a high economic impact and with a limited supply, which demand has increased substantially. Objective: To assess the usage of Ig according to the available clinical evidence in a tertiary hospital. Method: A retrospective observational study over a period of six months (January-June 2014), which included all the adult outpatients who received Ig.The variables included were age, sex, indication and clinical service. Using as a reference the Clinical Guidelines for immunoglobulin Use (Spanish Society of Hospital Pharmacy), the prescribed indications were categorized based on the available evidence. — Group A: Indications not listed on the product information label, though with a use based on consistent scientific evidence. — Group B: Indications with limited clinical evidence. — Group C: Not recommended indications. Results: 87 patients were included (60.9% males) whose median age was 59 years (19-91). 46 patients (52.9%) received Ig for indications listed on the product information label, and 41 (47.1%) for non-approved indications. Of the 41 off-label treatments, 29 corresponded to Group A (70.74%), 6 to B (14.63%) and 6 to C (14.63%). The Clinical Services involved were: Neurology (37 pacients), Hematology (18), Pneumology (14), Internal Medicine (10), Rheumatology (5), Immunodeficiency (2) and Digestive (1). All the patients of the B and C categories corresponded to Neurology. Conclusions: Approximately half of the indications in which Ig was used were not listed on the product information label. 29% of patients received Ig for indications with limited evidence of use or even not recommended. It is necessary to ensure an Ig prescription consistent with the available evidence, prioritizing its indications and applying criteria of selection and efficacy for optimizing its use
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