The use of IVIg in the treatment of inflammatory polyneuropathies and myasthenia gravis at The Walton Centre

• Main Authors: Selim Kimyongur, Brython Hywel, James Holt
• Format: Article
• Language: English
• Published: Royal College of Physicians of Edinburgh 2019-03-01
• Series: The Journal of the Royal College of Physicians of Edinburgh
• Subjects: CIDP; immunoglobulin; IVIg; myasthenia gravis; polyneuropathy; treatment
• Online Access: https://www.rcpe.ac.uk/sites/default/files/jrcpe_49_1_holt.pdf

Background Immunoglobulin is a blood product used in a variety of medical disorders, usually delivered intravenously (IVIg). Neurology patients, particularly those with inflammatory polyneuropathy, utilise a lot of IVIg. There is a national shortage of immunoglobulin and, thus, pressing need to ensure minimum effective dosing as well as rigorous outcome assessments to assess benefit at treatment start and subsequently, as placebo effects can be strong. Methods Serial audit of IVIg use at The Walton Centre against national guidelines was carried out through analysis of clinical notes of day unit patients. Review of the national immunoglobulin database and of neurology outpatient notes to benchmark our practice and provide some comparison with the wider nation was also performed. Results Serial audit led to improved adherence to guidelines, and analysis of practice identified wide variation in IVIg use. Conclusion Local audit and benchmarking of practice can be used to promote quality and consistency of IVIg use across the NHS.