Continuous increase of immunoglobulin therapy in Iceland

Abstract

• Immunoglobulin therapy is a beneficial treatment for a variety of registered and off-label • indications and use of immunoglobulin treatment has been continually increasing. We confirmed the increasing use of immunoglobulin in Iceland and conclude that continually increasing demand and global shortage dictates careful consideration of indications before initiating treatment with immunoglobulins. The use of immunoglobulin treatment has been increasing for various indications. The objective of this study was to evaluate clinical use of immunoglobulin therapy in Iceland, estimate off-label usage and describe possible changes in this treatment option. All prescriptions for intravenous or subcutaneous immunoglobulin treatment require authorisation from Landspitali University Hospital. Patient information is registered and was retrieved for the period 2010 to 2019. A total of 921 patients received immunoglobulin treatment in the study period, intravenous therapy was given in 895 (97.2%) of the cases. Registered indications were 667, off-label indications were 245 and uncertain were nine. The total annual number of patients receiving immunoglobulin treatment increased from 87 in 2010 to 392 in 2019. The increase in immunoglobulin usage was both for registered and off-label indications, 61 to 309 and 26 to 83, respectively. Continually increasing demand and global shortage dictates careful consideration of indications before initiating or continuing treatment with immunoglobulins. With global shortage of immunoglobulins, careful consideration and patient selection is important. Increasing immunoglobulin usage improves treatment for many patients. However, immunoglobulins are a limited resource and prudent use is imperative.