5PSQ-039 Profile of intravenous immune globulin utilisation in a Portuguese polyvalent hospital

<h3>Background and Importance</h3> Intravenous immune globulin (IVIG) is used as replacement and immunomodulation therapy in a variety of autoimmune and inflammatory disorders. The increase in IVIG prescription is a global problem, as it is a scarce, risky, and high cost drug, and its use after the Covid pandemic has worsened this scenario. The frequent supply disruptions reinforce the need for well-founded use of this drug. <h3>Aim and Objectives</h3> To describe the utilisation of IVIG to implement a strategic plan for its rational use. <h3>Material and Methods</h3> Observational, retrospective study carried out during a 2 year period (2022 and 2023) in a polyvalent hospital. Patients with IVIG prescribed were included. Variables analysed were demographics, indication (replacement <i>versus</i> immunomodulation therapy) and dosage of IVIG. Immunomodulation therapy indications were further divided into neuroimmunologic disorders, autoimmune/inflammatory conditions, infections and infection-related disorders, and alloimmune processes. Electronic medical records were consulted to collect this information. Statistical analysis was done in Excel . <h3>Results</h3> 81 patients were included (41 female, 50.6%), 65 adults (80%) and 16 children. The average age of adult patients was 60 years (23–91 years). The total amount of IVIG consumed was 12655 grams (5680 grams in 2022, 6975 grams in 2023). Regarding the indication, 71 patients received IVIG for immunomodulation therapy. In this subgroup of patients, the main indications were neuroimmunologic disorders (33) and autoimmune/inflammatory conditions (32). 10 patients were prescribed IVIG as replacement therapy (seven of which SARS-CoV-2 related). Among patients receiving IVIG for neuroimmunologic disorders, 26 (79%) were diagnosed with Guillain-Barré Syndrome. In the subgroup of patients with autoimmune/inflammatory conditions, the three major indications were Immune thrombocytopenia (44%), Myasthenia gravis (22%) and Autoimmune encephalitis (16%). Considering the indications approved for IVIG, 26 (32%) patients were prescribed IVIG for off-label indications. <h3>Conclusion and Relevance</h3> Our results show that major indications for IVIG prescription were neuroimmunologic disorders and autoimmune/inflammatory conditions, particularly Guillain-Barré Syndrome and Immune thrombocytopenia, respectively. Considering that one third of prescriptions were for off-label indications, and the increasing concern about shortages, a future development should focus on the elaboration of protocols for optimising IVIG utilisation, particularly in off-label indications, and an emergency plan in case of eventual future prolonged disruptions of supply of this high impact drug. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest