Abstract
Intravenous immune globulin (IVIg) use for labeled and unlabeled indications has grown in the last years. Aim of this study was to evaluate the IVIg usage profile for neurological inpatients in a single academic medical centre, over a long period of time. We retrospectively reviewed all approved IVIg transfusions for neurological disorders at Careggi Hospital from 2003 to 2006. The pharmacy records were then cross-referenced with patient medical records to determine the indication for IVIg administration. From 2003 to 2006 we observed a tremendous increase in IVIg administration, in the annual number of treated patients and in the mean annual courses. Fifty-seven patients (24%) received a long-term IVIg treatment, which accounted for 61% of the total IVIg consumption. The use of IVIg continues to expand despite concerns on future availability and long-term safety; alternative treatment strategies in chronic neurological disorders which require long-term, potentially indefinite therapy are warranted.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jolles S, Sewell WA, Misbah SA (2005) Clinical uses of intravenous immunoglobulin. Clin Exp Immunol 142:1–11
Lemieux R, Bazin R, Néron S (2005) Therapeutic intravenous immunoglobulins. Mol Immunol 42:839–848
Lin MW, Kirkpatrick PE, Riminton DS (2007) How intravenous immunoglobulin is used in clinical practice: audits of two Sydney teaching hospitals. Intern Med J 37:308–314
Hughes RA, Raphael JC, Swan AV, van Doorn PA (2004) Intravenous immunoglobulin for Guillain-Barre syndrome. Cochrane Database Syst Rev. CD002063
Hughes R, Bensa S, Willison H, Van den Bergh P, Comi G, Illa I, Nobile-Orazio E, van Doorn P, Dalakas M, Bojar M, Swan A, Inflammatory Neuropathy Cause, Treatment (INCAT) Group (2001) Randomized controlled trial of intravenous mmunoglobulin versus oral prednisolone in chronic inflammatory demyelinating polyradiculoneuropathy. Ann Neurol 50:195–201
Federico P, Zochodne DW, Hahn AF, Brown WF, Feasby TE (2000) Multifocal motor neuropathy improved by IVIg: randomized, double-blind, placebo-controlled study. Neurology 55:1256–1262
Gray O, McDonnell GV, Forbes RB (2003) Intravenous immunoglobulins for multiple sclerosis. Cochrane Database Syst Rev. CD002936
Dalakas MC, Illa I, Dambrosia JM, Soueidan SA, Stein DP, Otero C, Dinsmore ST, McCrosky S (1993) A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med 329:1993–2000
Gajdos P, Chevret S, Clair B, Tranchant C, Chastang C (1997) Clinical trial of plasma exchange and high-dose intravenous immunoglobulin in myasthenia gravis. Myasthenia Gravis Clinical Study Group. Ann Neurol 41:789–796
Wiles CM, Brown P, Chapel H, Guerrini R, Hughes RA, Martin TD, McCrone P, Newsom-Davis J, Palace J, Rees JH, Rose MR, Scolding N, Webster AD (2002) Intravenous immunoglobulin in neurological disease: a specialist review. J Neurol Neurosurg Psychiatry 72:440–448
Linker RA, Gold R (2008) Use of intravenous immunoglobulin and plasma exchange in neurological disease. Curr Opin Neurol 21:358–365
Feasby T, Banwell B, Benstead T, Bril V, Brouwers M, Freedman M, Hahn A, Hume H, Freedman J, Pi D, Wadsworth L (2007) Guidelines on the use of intravenous immune globulin for neurologic conditions. Transfus Med Rev 21(2 Suppl 1):S57–S107
Nimmerjahn F, Ravetch JV (2008) Anti-inflammatory actions of intravenous immunoglobulin. Annu Rev Immunol 26:513–533
Rodriguez M, Miller DJ, Lennon VA (1996) Immunoglobulins reactive with myelin basic protein promote CNS remyelination. Neurology 46:538–545
Gabriel CM, Gregson NA, Redford EJ, Davies M, Smith KJ, Hughes RA (1997) Human immunoglobulin ameliorates rat experimental autoimmune neuritis. Brain 120:1533–1540
Chan H, Heddle N (2004) Analysis of dosing variability of IVIG in community and teaching hospitals [abstract]. Blood 104:2726
Gajewski LK, Bailey EM, Brown PD, Chandrasekar PH (1994) Immune globulin use at a multihospital medical center. Am J Hosp Pharm 51:801–805
Lee YC, Woodfield DG, Douglas R (1998) Clinical usage of intravenous immunoglobulins in Auckland. N Z Med J 111:48–50
Chen C, Danekas LH, Ratko TA, Vlasses PH, Matuszewski KA (2000) A multicenter drug use surveillance of intravenous immunoglobulin utilization in US academic health centres. A multicenter drug use surveillance of intravenous immunoglobulin utilization in US academic health centers. Ann Pharmacother 34:295–299
Farrugia A, Poulis P (2001) Intravenous immunoglobulin: regulatory perspectives on use and supply. Transfus Med 11:63–74
Future Present Users of IVIG: A Canadian Multidisciplinary Consensus Building Initiative (1997) Can J Allergy Clin Immunol 2:176–208
Tumani H (2006) Rare indications of IVIG therapy in neurological diseases based on case reports and small studies. J Neurol 253(Suppl 5):V66–V69
Pendergrast JM, Sher GD, Callum JL (2005) Changes in intravenous immunoglobulin prescribing patterns during a period of severe product shortages, 1995–2000. Vox Sang 89:150–160
Finsterer J (2005) Treatment of immune-mediated, dysimmune neuropathies. Acta Neurol Scand 112:115–125
Dalakas MC (2002) Mechanisms of action of IVIg and therapeutic considerations in the treatment of acute and chronic demyelinating neuropathies. Neurology 59:S13–S21
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sarti, L., Falai, T., Pinto, F. et al. Intravenous immune globulin usage for neurological and neuromuscular disorders: an academic centre, 4 years experience. Neurol Sci 30, 213–218 (2009). https://doi.org/10.1007/s10072-009-0043-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-009-0043-9