Immunoglobulin shortage: Practice modifications and clinical outcomes in a reference centre

E N'kaoua; S Attarian; E Delmont; E Campana-Salort; A Verschueren; A-M Grapperon; E Mestivier; M Roche

doi:10.1016/j.neurol.2021.10.004

Immunoglobulin shortage: Practice modifications and clinical outcomes in a reference centre

Rev Neurol (Paris). 2022 Jun;178(6):616-623. doi: 10.1016/j.neurol.2021.10.004. Epub 2021 Nov 27.

Authors

E N'kaoua¹, S Attarian², E Delmont³, E Campana-Salort³, A Verschueren³, A-M Grapperon³, E Mestivier¹, M Roche⁴

Affiliations

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; Aix Marseille Univ, Inserm UMR 1251, Marseille, France. Electronic address: shahram.attarian@ap-hm.fr.
³ Assistance Publique-Hôpitaux de Marseille, Centre de référence des maladies neuromusculaires et SLA, Hôpital Timone, Marseille, France.
⁴ Assistance Publique-Hôpitaux de Marseille, Service Central des Opérations Pharmaceutiques (SCOP), Marseille, France; Aix Marseille Univ, ICR, UMR CNRS7273, Marseille, France.

PMID: 34872746
DOI: 10.1016/j.neurol.2021.10.004

Abstract

Background: Growing 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.

Methods: All patients treated with IVIg for chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy and myasthenia gravis from October 2017 to October 2018 were included.

Results: Out 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).

Conclusion: Our 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.

Keywords: Drug shortage; Dysimmune neuromuscular diseases; Intravenous immunoglobulins; Prescription drugs; Treatment Outcome.

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Humans
Immunoglobulins, Intravenous / therapeutic use
Myasthenia Gravis* / drug therapy
Polyneuropathies* / drug therapy
Polyradiculoneuropathy, Chronic Inflammatory Demyelinating* / diagnosis
Polyradiculoneuropathy, Chronic Inflammatory Demyelinating* / drug therapy

Substances

Adrenal Cortex Hormones
Immunoglobulins, Intravenous