Use in pediatrics
The prescribing habits of IVIG in pediatrics on an annual per gram basis remained relatively constant over the two assessment years. Officially licensed indications in Canada represented 62% of known use in the pediatric setting. The number of indications with more than 5% annual use in 1997 and 1998 were seven and eight, respectively, which also accounted for approximately 82% of the known use in each year (Table 4). In addition, only 12 indications had an incidence of over 1% total IVIG use, which on average over the two years accounted for 89% of the total of known pediatric IVIG use. ventolin inhaler
TABLE 4 Indications with more than 5% intravenous immune globulin (IVIG) annual use in any year (pediatric population)
Figures 1 and 2 display appropriate use of IVIG for both adult and pediatric settings, respectively. Of the 84 off-label indications reported in this study, 20 were deemed to be appropriate, 40 were deemed to be inappropriate and 24 required future research. Even though 40 indications were inappropriate, these represented a very small proportion of overall use (less than 5% in any year) and they represented only 6% (114 of 1904) of the total number of patients who had been prescribed IVIG in this period of observation. In adults for all three years surveyed, the top five most frequently reported inappropriate uses were for lupus (1.3%), immune system disorder (1.1%) maternal antibody (0.4%), purpura (0.3%) and vasculitis (0.2%), where the percentage of each of these indications individually represented 0.2% to 1.3% of the total known use. In pediatrics, for both years surveyed, the top five most frequently reported inapproriate uses were for central nervous system neoplasia (0.8%), lupus (0.7%), peripheral neuritis (0.41%), polyarteritis nodosa (0.3%) and bone neoplasm (0.3%), where the percentage of each of these indications individually represented 0.3% to 0.8% of total known use. Figures 1 and 2 combine all IVIG use (labelled and off-label) and show that only up to 5.4% in the adult and the pediatric settings could be consid’ ered inappropriate in any given year.
Figure 1) Appropriate use of intravenous immune globulin in adults between 1997 and 1999
Figure 2) Appropriate use of intravenous immune globulin in pediatrics between 1997 and 1999