Immunoglobulin shortage: Practice modifications and clinical outcomes in a reference centre |
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| Affiliation: | 1. Assistance Publique–Hôpitaux de Marseille, Service Central des Opérations Pharmaceutiques (SCOP), Marseille, France;2. Assistance Publique–Hôpitaux de Marseille, Centre de référence des maladies neuromusculaires et SLA, Hôpital Timone, Marseille, France;3. Aix Marseille Univ, Inserm UMR 1251, Marseille, France;4. Aix Marseille Univ, ICR, UMR CNRS7273, Marseille, France;1. InsermU1144, université de Paris, Paris, France;2. Centre de Neurologie Cognitive/CMRR Paris Nord Île-de-France, Lariboisière Fernand-Widal hospital, université de Paris, GHU AP–HP Nord, Paris, France;3. Centre urgences céphalées, Lariboisière Fernand-Widal hospital, université de Paris, GHU AP–HP Nord, Paris, France;1. Postgraduate Program in Health Sciences, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, São Paulo, Brazil;2. School of Medicine, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, São Paulo, Brazil;1. Movement disorders department, CHU Lille, 59000 Lille, France;2. University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 59000 Lille, France;3. Hôpital Delafontaine, Neurology Department, 93200 St Denis, France;4. University Lille, CHU Lille, U2694 METRICS, 59000 Lille, France;1. Service d’ENMG et pathologies neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France;2. Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Lyon, France;3. Service de Neurologie, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France;1. Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59, boulevard Pinel, 69500 Bron, France;2. CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude-Bernard Lyon I University, 7, avenue Jean-Capelle O, 69100 Villeurbanne, France;3. Stroke Department, East Group Hospital, Hospices Civils de Lyon, 59, boulevard Pinel, 69500 Bron, France;4. CarMeN Laboratory, INSERM U1060, Claude-Bernard Lyon I University, 59, boulevard Pinel, 69500 Bron, France;1. Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan;2. Department of Lifetime Clinical Immunology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan;3. Department of Pediatrics, Nerima Hikarigaoka Hospital, Tokyo, Japan;4. Department of Child Health and Development, Tokyo Medical and Dental University (TMDU), Tokyo, Japan |
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| Abstract: | ![]()
BackgroundGrowing numbers of indications for intravenous immunoglobulins (IVIg) in recent years has resulted in an increase in the consumption of these products. A lack of raw material has led to IVIg shortage. The objective of this work was to evaluate the impact of this situation on patient care in one French referral centre considering practice modifications and clinical impact.MethodsAll patients treated with IVIg for chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy and myasthenia gravis from October 2017 to October 2018 were included.ResultsOut of 142 patients, 111 (78%) had a modification of their IVIg treatment. We noted that 75 (68%) patients had a delay in IVIg treatment, 41 (37%) patients had a decrease in IVIg doses and 31 (28%) experienced IVIg treatment interruption. Thirty percent of patients for whom IVIg treatment was discontinued were switched to other treatments mainly plasma exchange (16%) or corticosteroids (13%). Switches to plasma exchange or corticosteroids were carried out in order to save immunoglobulins for patients who had no other alternatives. Fifty-eight (52%) patients presented a deterioration of their clinical score after IVIg treatment changes including 31 (28%) patients who had a moderate or a clinically significant deterioration. Concerning practice modifications, we noted a substantial though not significant decrease in median IVIg dose for myasthenia gravis and a significant increase in the delay between IVIg courses for chronic inflammatory demyelinating polyneuropathy and multifocal motor neuropathy (P = 0.011 and P = 0.018 respectively).ConclusionOur study showed a rather important number of changes in IVIg treatment related to IVIg shortage during the period considered. These changes had a negative impact on the clinical status of some patients. |
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