One-year consumption pattern of intravenous immunoglobulin at a teaching hospital in Sari

Mohammadreza Rafati; Ebrahim Salehifar; Kaveh Jafari; Sima Sahraee; Amirmohammad Rafati; Razieh Avan

doi:10.18502/jppm.v9i1.12880

Mohammadreza Rafati Pharmaceutical Sciences Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
Ebrahim Salehifar Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
Kaveh Jafari Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
Sima Sahraee Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
Amirmohammad Rafati Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Razieh Avan Department of Clinical Pharmacy, School of Pharmacy, Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences,Birjand, Iran

DOI: https://doi.org/10.18502/jppm.v9i1.12880

Keywords: Drug utilization evaluation, Intravenous immunoglobulin, FDA label indication.

Abstract

Background: There is an increasing trend to use intravenous immunoglobulin (IVIG) for new indications, mainly off-labeled conditions for numerous diseases. IVIG is an expensive drug and is occasionally not available, so it is recommended that medical centers evaluate how to use it permanently. This study aimed to assess the pattern of IVIG use in an educational hospital.

Methods: All patients who received IVIG for any condition for a year were enrolled in this cross-sectional observational study. A predesigned checklist form was used to gather demographic, clinical, and biochemical data. The collected data were compared to the FDA recommendations for IVIG use.

Results: Overall, in 62.8% of the patients, IVIG was administrated for FDAapproved indications, 21.2% for off-label uses, and the remaining 16% for investigational conditions. The most common cause of IVIG use was for primary immunodeficiency disease (PID) in 22 patients (19.5%). The highest prevalence of primary diagnoses in patients receiving IVIG was immune thrombocytopenic purpura (ITP). In addition, Chronic inflammatory demyelinating polyneuropathy (CIDP) (28.4%) and final diagnoses were ITP and Guillain-Barré syndrome (GBS) in 30% of patients. 26.5% of patients experienced side effects, and headache, fever and chills, and inflammation of the injection site were the most common adverse drug reactions.

Conclusion: National or local drug protocols are needed to prescribe more rational IVIG utilization and assist physicians in using IVIG for approved or high evidence-based indications.