Use of Intravenous Immunoglobulins - A review of management strategy experiences and the available evidence

Immunoglobulins (Igs) are therapeutic preparations of polyvalent human immunoglobulins extracted from blood plasma. The presence of a wide array of antibodies confers on them a broad spectrum of immune reactivity. Intravenous Igs (IVIgs) are used as a replacement for Igs in the treatment of primary and secondary immune deficiencies. They are also used as immunomodulatory therapy for a number of autoimmune and inflammatory diseases.

The increasing demand for IVIgs, has quickly encountered two major problems: the high production cost and a varying supply, since the supply depends on blood donations. This imbalance between IVIg supply and demand risked degenerating into a shortage, which would have put many patients' survival and quality of life at risk.

In Québec, the issue of IVIg availability has, for a number of years, also been a concern for the bodies involved in the management of the blood system, namely the ministère de la Santé et des Services Sociaux (MSSS), the Comité consultatif national en médecine transfusionnelle (CCNMT) and Héma-Québec, the organization responsible for Québec’s blood and blood product supply. In addition to this concern is the insuficiency of the rules governing IVIg use in hospitals, especially with regard to neurological indications. On the CCNMT's suggestion, the MSSS decided to call on the Institut national d’excellence en santé et en services sociaux (INESSS)’s expertise with a view to INESSS being involved in developing recommendations regarding IVIg use in neurology.

This information brief outlines the more general context regarding the need for such recommendations, as evidenced by the government experiences involving this issue, and describes the availability of recent guidelines and narrative and systematic reviews published in the scientific literature. Special attention is given to the neurological indications, which are increasing in number and already account for a considerable proportion of total IVIg use.