Intravenous Human Immunoglobulin usage profile in a university hospital in Rio de Janeiro

Abstract

Objective: Identify the IVIg indication profile, the rational use according to the indications contemplated by the CEAF/MS and data available in literature. Methods: a retrospective descriptive study was carried out at a University Hospital in Rio de Janeiro through the analysis of prescriptions of IVIg. Electronic medical records of inpatients were evaluated between January 2014 and June 2019. Data collected included age, sex, ICD-10 indication, number of cicles, predictability of use (situation in which the hospitalization is scheduled predicting the use of IVIg) and the financial resources mobilized. Results: The sample consisted of 199 cycles of use referring to 138 patients, the ICD-10 group with the highest number of indications was G00-G99 (diseases of the nervous system) (66 cycles; 33.2%) and M00-M99 (diseases of the musculoskeletal system and tissue connective tissue) (57 cycles; 28.6%), followed by D50-D89 (diseases of the blood and hematopoietic organs and some immune disorders) (43 cycles; 21.6%). Overall, 36.2% (72 cycles) of the indications were for diseases that are covered by CEAF/MS and there was an occurrence of 30.2% (60 cycles) of predictability of use at the time of hospitalization. About the historical series, there is some consistency in the frequency of almost all indications, except for expressive growth in the frequency of treatments for rheumatological and dermatological conditions. During the evaluated period, only one cycle was provided by CEAF/MS, in the other cases, the hospital paid for the cost of all treatments using its own resources, which represented an annual average of 7.3% of all the institution’s expenditure on medicines. Conclusion: the study showed a high percentage of use in indications not covered by national protocols. Indications related to skin and subcutaneous tissue diseases, followed by diseases of the musculoskeletal system and connective tissue, were the groups that had the highest percentage of indication without CEAF/MS coverage. More robust studies are needed to support the use of IVIg in these situations, especially given its high cost and potential budgetary impact. It is important that institutions mobilize themselves to develop strategies to promote rational use, especially through the Pharmacy and Therapeutics Commission and Clinical Pharmacy services.