Transcript Clinical Guidelines for Immunoglobulin Use

Clinical Guidelines for
Immunoglobulin Use
Welcome
Denise O’Shaughnessy
Clinical Guidelines for
Immunoglobulin Use
Overview of changes
Aidan McManus
OUTLINE
• Where are the guidelines?
• Major changes to guidelines
• Minor changes to guidelines
Where are the guidelines?
Where are the guidelines?
www.dh.gov.uk/en/Publicationsandstatis
tics/Publications/PublicationsPolicyAndG
uidance/DH_129617
DH_129617
Audio slide presentations online
www.ivig.nhs.uk
Second edition update
2008
2011
Second edition update
2008
2011
Second edition update
Major changes
1. Selection criteria for appropriate use
of immunoglobulin
2. Efficacy outcomes to assess treatment
success
3. Modification of existing indications
and inclusion of new indications
Haemophagocytic lymphohistiocytosis –
2008
Total Grams Infused for Haematology Q1 2010
Diagnosis
Grams Used
% Of Total
31111.5
55.17%
Other (Haematology)
9820
17.41%
Autoimmune thrombocytopenia (see ITP)
6795
12.05%
Autoimmune haemolytic anaemia
2735
4.85%
Alloimmune thrombocytopenia - fetal therapy (treatment to the mother)
2665
4.73%
Idiopathic thrombocytopenic purpura ( >16 years)
960
1.70%
Haemophagocytic lymphohistiocytosis/haemophagocytic syndrome
621
1.10%
Acquired von Willebrand disease
487
0.86%
Post-transfusion hyperhaemolysis (usually in patients with sickle cell disease)
300
0.53%
Acquired red cell aplasia due to parvovirus B19
285
0.51%
Other (Other)
230
0.41%
Evans' syndrome
110
0.20%
Adult HIV-associated thrombocytopenia
105
0.19%
Primary immunodeficiencies - Hypogammaglobulinaemia
60
0.11%
Systemic lupus erythematosus with secondary immunocytopenias
50
0.09%
Haemolytic uraemic syndrome
37.5
0.07%
Alloimmune thrombocytopenia - neonatal therapy
12.5
0.02%
10
0.02%
Idiopathic thrombocytopenic purpura - adult
Haemolytic disease of the fetus and newborn (isoimmune haemolytic jaundice in neonates)
Australian guideline
Haemophagocytic lymphohistiocytosis –
2011
Second edition update
1. Selection criteria for appropriate use
of immunoglobulin
2. Efficacy outcomes to assess treatment
success
3. Modification of existing indications
and inclusion of new indications
Australian guideline
Haemophagocytic lymphohistiocytosis –
2011
Australian guideline
Efficacy monitoring
“The update specifies the
outcome(s) measures, but not
the degree in improvement of
outcome(s) required to
constitute treatment success”
Commissioners will work with
expert clinicians to refine these
outcomes to provide defined
‘treatment success’ measures
where possible.
Second edition update
1. Selection criteria for appropriate use
of immunoglobulin
2. Efficacy outcomes to assess treatment
success
3. Modification of existing indications
and inclusion of new indications
Immunoglobulin use in haematology
2010 database report
Grouping of diseases under single
headings
Changes to the colour-coded prioritisation in
the Demand Management Programme
Grey to Blue
The database review identified two of the top 10 immunoglobulin-using
indications as Grey (secondary antibody deficiencies and antibody-mediated
rejection following solid organ transplantation).
In the previous edition, they were listed under immunosuppressive
pharmacotherapy, and separately under some of the haematological
malignancies such as CLL, without listing other mature B-cell malignancies
such as non-Hodgkin’s lymphoma. These have been revised into a single
indication.
Antibody-mediated rejection following solid organ transplantation and
antibody-incompatible transplantation were reviewed, and a single grouping
of ‘Transplantation (solid organ)’ has been introduced and listed as Blue.
Changes to the colour-coded prioritisation in
the Demand Management Programme
Grey to Blue
Acquired von Willebrand disease has now been included with acquired
haemophilia, in the general disease grouping of ‘Coagulation factor inhibitors’.
Polymyositis and Inclusion body myositis have now been grouped with
dermatomyositis under the general disease grouping of inflammatory
myopathies, with strict selection criteria.
Post-transfusion hyperhaemolysis has now been grouped under the more
general heading of haemolytic anaemia.
SLE with secondary immunocytopenias should be considered under the
relevant immune cytopenia.
Changes to the colour-coded prioritisation in
the Demand Management Programme
Blue to Red
Specific antibody deficiency, as a recognised primary antibody deficiency
disorder, has been reclassified as a Red indication (for those cases where
immunoglobulin replacement therapy is required).
Haemolytic disease of the newborn has been updated to reflect
recommendations in ‘NICE clinical guideline 98’ on neonatal jaundice.
Second edition update
Minor changes
1. Definitions of duration of
immunoglobulin treatment
2. Recommended dosing of
immunoglobulin
3. Ideal body weight-adjusted dosing of
immunoglobulin
Definitions of duration of
immunoglobulin treatment
Recommended dosing of
immunoglobulin
Ideal body weight-adjusted dosing of
immunoglobulin
Database update will reflect advice
and updated terminology