Following a critical shortage of IVIG in the UK in 2006, the DoH commissioned a review of use. There was a perception that unlicensed indications for IVIG were proliferating without supportive clinical evidence, and that usage was increasing. The Demand Management Plan, Clinical Guidelines for IVIG use and the IVIG Database were the result.
In year 1 the IVIG Database captured approximately 60% of IVIG use. Almost 500 000 g of IVIG (costing approximately £15 million) was infused for neurological indications. UK usage is static. Neurologists use 43% of total IVIG. 85% of the IVIG is used for CIDP, GBS, MMNCB and myasthenia gravis. Only 7% is used for indications with little evidence for use (“grey” indications in the Demand Management Plan). For indications where there is evidence for no benefit, only nine patients received 0.2% of the total IVIG use, 4/9 of these having received permission for exceptional use.
The DoH has commended UK Neurologists on their appropriate, evidence-based prescribing. In year 2 of the database changes will be made to improve the quality of the data and achieve 100% data entry. Clinical trials in myasthenia gravis and other rarer conditions are needed to clarify the evidence for benefit. Evidence to support an update the Clinical Guidelines in 2010 is welcomed.
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