Drug Use Evaluation of Human Intravenous Immunoglobulin (IVIG) in a Teaching Hospital in East of Iran
Abstractdifferent indications that only a few of them is now approved by the Food and Drug Administration (FDA) as primary immunodeficiency, idiopathic thrombocytopenic purpura (ITP). Although it has been approved for selected indications, the list of its clinical indications, particularly off-labels, has grown considerably. Unfortunately, many of these conditions, lack sufficient clinical data of efficacy and might not always be appropriate.Method: It was a cross sectional study performed in Amir-al-momenin teaching hospital affiliated to Zabol University of medical sciences. All hospitalized patients who received IVIG during a 6 month period (autumn and winter 2015) were included in this study. We used predesigned data collection forms for data gathering as patient’s demographics, diagnoses, as well as drug related data, such as dose regimen, duration, rate of infusion, any related lab test.Results: In this study total of 49 patients received IVIG. Only in 25 cases, the mentioned indications were FDA approved (51%).Total of 189 IVIG vials (945 grams) that cost 146,475,000 Tomans (39481 USD) was administered during this study period, of which 560 grams (112vials) (59.2%) were used for FDA approved indications. From 19 ITP patients only 6 (12.2%) fulfilled the criteria for IVIG therapy. Considering cases of wrong doses and whom were not indicated to receive IVIG therapy, total of (93 vials) 465 grams, that cost 72,075,000 Tomans (19427 USD) were spent irrationally.Conclusion: We concluded that IVIG was widely used irrationally in our institution and cost of this irrational administration is huge. This fact justifies the need for establishing multidisciplinary supervisory procedure in our hospital.
Schwab I, Nimmerjahn F. Intravenous immunoglobulin therapy: how does IgG modulate the immune system? Nat Rev Immunol. 2013;13(3):176-89.
Lucas M, Lee M, Lortan J, Lopez-Granados E, Misbah S,Chapel H.
Infection outcomes in patients with common variable immunodeficiencydisorders: relationship to immunoglobulin therapy over 22 years. J AllergyClin Immunol 2010;125(6): 1354-1360.e4.
Perez EE, Orange JS, Bonilla F, et al. Update on the use of immunoglobulinin human disease: A review of evidence. J Allergy Clin Immunol2017;139(3S):S1-S46.
YangL, WuEY, TarrantTK.Immune Gamma Globulin Therapeutic
Indications in Immune Deficiency and Autoimmunity. Curr Allergy AsthmaRep. 2016;16(8):55.
AmmannEM, HaskinsCB, FillmanKM,etal.Intravenous immune globulinand thromboembolic adverse events: A systematic review and meta-analysisof RCTs. Am J Hematol 2016 ;91(6):594-605.
National Center for Immunization and Respiratory Diseases. Generalrecommendations on immunization --- recommendations of the AdvisoryCommittee on Immunization Practices (ACIP). MMWR Recomm Rep2011;60(2):1-64.
Gelfand EW. Intravenous immune globulin in autoimmune and inflammatorydiseases. N Engl J Med 2012;367(21):2015-25.
Rocchio MA, Schurr JW, Hussey AP, Szumita PM. Intravenous ImmuneGlobulin Stewardship Program at a Tertiary Academic Medical Center. AnnPharmacother 2017;51(2):135-139
Dawoud T, Tatari H, Gebran N. A utilization review of intravenous
immunoglobulin in a tertiary care hospital in United Arab Emirates. European Journal of Hospital Pharmacy: Science and Practice 2012;19(3):286-8.
The University of Mississippi Medical Center, The University of Mississippi Health Care, Pharmacy and Therapeutics Committee, Medication UseEvaluation, June 2012.
Alangari AA, Abutaleb MH, Albarraq AA, Al-Dhowailie AA. Intravenousimmunoglobulin utilization in a tertiary care teaching hospital in SaudiArabia. Saudi Med J 2008;29(7):975-9.
Sohrevardi S, Shafiei A, Mirzania S. Intravenous Immunoglobulin: A Drug Utilization Review at Shahid Sadoughi Hospital in Yazd. J Pharm Care 2015;2(4):170-6.