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Immunoglobulin rationalisation plan in a tertiary hospital during shortage by COVID-19 pandemic

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European Statement

Clinical Pharmacy Services

Author(s)

MARIA DE LA TORRE ORTIZ, ESTEFANIA ROSON, LIDIA YBAÑEZ, NATALIA SANCHEZ-OCAÑA, JAVIER CORAZON, PALOMA PASTOR, MARIA FERNANDEZ-VAZQUEZ, JOSE MANUEL MARTINEZ SESMERO

Why was it done?

The demand and use of immunoglobulins (IgGs) is growing, and there are many difficulties in obtaining supplies. This situation has been worsened during and especially after COVID-19 pandemic. A low number of blood donations and apheresis procedures, caused a shortage of IgGs worldwide. The measures implemented (dose and period optimisation) ensured the achievement of an adequate balance between supply and demand, enabling an increase of plasma fractionation industry.

What was done?

A rationalisation plan of human IgGs use was implemented in a tertiary hospital through the multidisciplinary groups, in which Pharmacy Department (PD) participated.

How was it done?

Inside hospital working groups were created between the different IgGs prescribing departments (paediatrics, haematology, immunology and neurology) and PD during a period between 1 May 2021 and 31 October 2021. All patients on regular treatment with IgGs were identified and each one was reviewed: indication, dose, regimen and treatment alternatives. Based on the document “Criteria for the rational use of human immunoglobulins” published by the Madrid Health Service in 2021 and taking into account the clinical circumstances of each patient, decisions were made regarding: continuation or discontinuation of treatment and dose or regimen adjustments.

What has been achieved?

After identifying 184 patients treated with IgGs, a set of pharmaceutical policies has been drawn up in conjunction with stakeholders. Evidence-based intervention focused on assessing the clinical adequacy of actual treatments, optimising indications and dosing, to ensure an equitable supply was done. A total of 34 patients (%) discontinued IgGs, 24 patients reduced doses and 15 increased time between administrations.
As a result, it has been possible to continue the treatment in those patients for whom its use was a vital urgency during shortage period.

What next?

Long-term follow-up is necessary to better analyse the impact of the established measures. Registries play an important role in collection of systematic data to analyse, synthetise, and obtain valuable information for decision support. five patients had to restart IgGs treatment and seven patients had to come back to the initial regimen. Even so, politic rationalisation in special situations is a key factor of pharmaceutical activity to ensure treatments for patients who need it the most.

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