The data showed that IVIG was used in a total of 90 different indications in both adult and pediatric settings, 84 of which were off-label uses (Table 1). When considered as separate populations, adult and pediatric use accounted for 61 and 65 different indications, respectively. asthma inhalers
TABLE 1 Listing of all indications reported for adult and pediatric populations
Table 2 displays the number of different indications reported in both populations on an annual basis. The majority of reported indications on an annual basis (up to 81%) can be considered miscellaneous and rare in terms of overall known IVIG use because each miscellaneous indication represented 1% or less of the total reported annual use of IVIG in any given year.
TABLE 2 Number of different indications by Coding Symbols for Thesaurus of Adverse Reaction Terms (COSTART) reported annually (adult and pediatric populations)
*Major indications: total number of indications that each represent more than 1% annual intravenous immune globulin use; fMiscellaneous indications: total number of indications that each represents less than 1% annual intravenous immune globulin use
A total of 277,591 g of IVIG was prescribed to 1014 adult patients and 890 pediatric patients over the years surveyed. Ninety indications were documented for 205,577 g of usage. The remaining grams (26%) constituted use in unknown indications that were either not captured by the blood bank databases or which used an indecipherable acronym.
Use in adults
Table 3 displays IVIG use in adults. The total annual usage of IVIG increased over the three-year assessment period. Licensed indications represented 47% of known use in the adult setting. Only five individual indications were shown to have been prescribed a significant amount (more than 5% of total annual IVIG use) of IVIG over any given year. These top five indications listed in Table 3 accounted for 70% of the known usage over three years, three of which are labelled indications and the other two are off-label neurological indications. However, irrespective of off-label status, these top five indications were all deemed as ‘appropriate use’. In addition, only 20 indications had an incidence of greater than 1% total IVIG use, which, on average, over the three years accounted for 85% of the total of known adult IVIG use.
TABLE 3 Indications with more than 5% intravenous immune globulin (IVIG) annual use in any year (adult population)