IVIG: sixyear data

1
Intravenous Immune Globulin (IVIG) Six-year
data K Eckert, S McManus, K de Ruiter, K Leigh, I
Chin-Yee London Laboratory Services Group
(LLSG), London ON

• Results
• Figure 5 indicates the percentage of IVIG issued
  to each specialty.
• In each of the 3 years studied, the Neurology
  specialty was the largest user, followed by
  Rheumatology, Immunology and Hematology.
• The number of patients receiving IVIG per
  specialty is reflected in Figure 6. Once again,
  the largest numbers of patients are in the
  Neurology service. Pediatric indications account
  for the second highest number of patients,
  however each of the pediatric doses are
  comparatively small and are often single dose.
  For this reason, pediatric indications do not
  account for a high percentage of IVIG use.
• Figure 7 shows the percentage of IVIG used for
  the main indications within each specialty. The
  top 3 indications in all 3 years are Chronic
  Immune Demyelinating Polyneuropathy (20),
  Immune Deficiency (12) and Multifocal
  Conduction Block Neuropathy (11).
• Amount of IVIG issued for Neurology indications
  has almost doubled over the past 3 years. There
  has been a slight increase in the amount issued
  to Immunology, but an actual decrease for
  Hematology and Rheumatology indications. The
  amount of IVIG issued to the top 3 services in
  the past 3 years is shown in Figure 8.

• Introduction
• There has been an expanding use of Intravenous
  Immunoglobulin (IVIG) since it was licensed in
  the early 1980s. Immunoglobulins were initially
  used in the 1950s for the treatment of primary
  immunodeficiency disorders, but were restricted
  to intramuscular or subcutaneous administration
  and limited dosage and frequency. In the late
  1970s, the highly purified monomeric suspensions
  of IgG were developed. With the ability to
  administer this product intravenously and at
  higher doses, many additional autoimmune and
  inflammatory conditions were identified that
  might benefit from the use of IVIG, and so began
  the escalation in the demand for IVIG. Figure 1
  shows the increase in worldwide IVIG utilization
  since 1984. 1
• Canada has been been one of the highest IVIG
  users per capita in the world, with an annual
  increase in the use of IVIG as seen in Figure 2.
  2
• London also experienced an annual increase in the
  amount of IVIG transfused. Since 2000, there has
  been a 37 increase. (See Figure 3)
• Analyzing the increasing trend in London was
  hampered by the lack of information such as
  diagnosis, dosage or physician specialty. As a
  result, there was an inability to determine
  whether the increase was due to labeled
  indications, off-label indications or a
  combination of both.
• In this retrospective audit, we report the
  utilization of IVIG in the 2 tertiary care
  hospitals (London Health Sciences Centre and St
  Josephs Health Care) serviced by London
  Laboratory Services Group (LLSG). We compare both
  approved indications and off-label utilization
  including amount of IVIG ordered by medical
  specialty and patient diagnosis.

Figure 5 Percent of Total IVIG used by Service
Figure 1 World IVIG Demand 1984 2004 (Kilos)
Figure 2 Canadian Statistics2
Figure 7 Percent of IVIG used per specialty
and top indications within specialty

• Method
• A pre-approved list of indications for IVIG has
  been established for the two teaching hospitals
  (London Health Sciences Centre and St Josephs
  Health Care) serviced by London Laboratory
  Services Group. This includes both labeled and
  the off-label indications that the London
  Transfusion Committee felt had enough scientific
  evidence to support the issue of IVIG. If the
  indication falls outside of this pre-approved
  list, the attending physician must discuss the
  need for IVIG with a hematologist.
• A request form (see Figure 4) is completed for
  all initial requests for IVIG.
• Since 2003, this data has been collected and
  reviewed including amount of IVIG ordered,
  medical specialty and patient diagnosis.

May 2006