PMID- 27242065
OWN - NLM
STAT- MEDLINE
DCOM- 20170510
LR  - 20191210
IS  - 1469-8749 (Electronic)
IS  - 0012-1622 (Linking)
VI  - 58
IP  - 11
DP  - 2016 Nov
TI  - Intravenous immunoglobulin in paediatric neurology: safety, adherence to 
      guidelines, and long-term outcome.
PG  - 1180-1192
LID - 10.1111/dmcn.13159 [doi]
AB  - AIM: Intravenous immunoglobulin (IVIG) is an expensive therapy used in 
      immunodeficiency and autoimmune disorders. Increasing demands and consequent 
      shortages result in a need for usage to conform to guidelines. METHOD: We 
      retrospectively evaluated IVIG use for neuroimmunological indications and 
      adherence to existing guidelines in a major Australian paediatric hospital 
      between 2000 and 2014. RESULTS: One-hundred and ninety-six children (96 male, 100 
      female; mean age at disease onset 6y 5mo [range 3mo-15y 10mo], mean age at first 
      IVIG dose 7y 2mo [range 3mo-16y 5mo]) received IVIG for neuroimmunological 
      indications during the study period (28.1% had Guillain-Barre syndrome), 
      representing 15.5% of all hospital indications. In total, 1669 IVIG courses were 
      administered (total 57 221g, median 78g/patient, range 12-5748g). The highest 
      median numbers of courses were in chronic inflammatory demyelinating 
      polyneuropathies, opsoclonus-myoclonus ataxia syndrome, suspected immune-mediated 
      epilepsies, and Rasmussen's encephalitis. Adverse reactions occurred in 25.5% of 
      patients, but these were mostly minor. Outcome at follow-up was best in 
      anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, Guillain-Barre 
      syndrome, and myasthenia gravis, and worst in Rasmussen's encephalitis and 
      epilepsies. The total cost of IVIG was US$2 595 907 (median $3538/patient, range 
      $544-260 766). Of patients receiving IVIG, 45.4% to 57.1% were given the therapy 
      for 'weak' indications or indications 'not listed' in international guidelines. 
      Some entities commonly treated with IVIG in current practice, such as anti-NMDAR 
      encephalitis and transverse myelitis, are not listed in most guidelines. 
      INTERPRETATION: Our study demonstrates that IVIG is generally well tolerated but 
      expensive, and discloses discrepancies between guidelines and clinical practice 
      in paediatric neurology, suggesting both the need for greater adherence to 
      current recommendations, and for recommendations to be updated to accommodate 
      emerging indications.
CI  - (c) 2016 Mac Keith Press.
FAU - Nosadini, Margherita
AU  - Nosadini M
AD  - Neuroimmunology Group, Institute for Neuroscience and Muscle Research, Kids 
      Research Institute, Children's Hospital at Westmead, University of Sydney, 
      Sydney, NSW, Australia.
AD  - Paediatric Neurology Unit, Department of Paediatrics, University of Padua, Padua, 
      Italy.
FAU - Mohammad, Shekeeb S
AU  - Mohammad SS
AD  - Neuroimmunology Group, Institute for Neuroscience and Muscle Research, Kids 
      Research Institute, Children's Hospital at Westmead, University of Sydney, 
      Sydney, NSW, Australia.
FAU - Suppiej, Agnese
AU  - Suppiej A
AD  - Paediatric Neurology Unit, Department of Paediatrics, University of Padua, Padua, 
      Italy.
FAU - Sartori, Stefano
AU  - Sartori S
AD  - Paediatric Neurology Unit, Department of Paediatrics, University of Padua, Padua, 
      Italy.
FAU - Dale, Russell C
AU  - Dale RC
AD  - Neuroimmunology Group, Institute for Neuroscience and Muscle Research, Kids 
      Research Institute, Children's Hospital at Westmead, University of Sydney, 
      Sydney, NSW, Australia. russell.dale@health.nsw.gov.au.
CN  - IVIG in Neurology Study Group
AD  - Neuroimmunology Group, Institute for Neuroscience and Muscle Research, Kids 
      Research Institute, Children's Hospital at Westmead, University of Sydney, 
      Sydney, NSW, Australia.
LA  - eng
PT  - Journal Article
DEP - 20160531
PL  - England
TA  - Dev Med Child Neurol
JT  - Developmental medicine and child neurology
JID - 0006761
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunologic Factors)
SB  - IM
CIN - Dev Med Child Neurol. 2016 Nov;58(11):1105-1106. PMID: 27358086
MH  - Adolescent
MH  - Australia
MH  - Autoimmune Diseases of the Nervous System/*drug therapy
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Follow-Up Studies
MH  - Guideline Adherence/*standards/statistics & numerical data
MH  - Hospitals, Pediatric/statistics & numerical data
MH  - Humans
MH  - Immunoglobulins, Intravenous/administration & dosage/adverse 
      effects/economics/*therapeutic use
MH  - Immunologic Factors/administration & dosage/adverse 
      effects/economics/*therapeutic use
MH  - Infant
MH  - Male
MH  - Neurology/*standards/statistics & numerical data
MH  - Outcome Assessment, Health Care/statistics & numerical data
MH  - Pediatrics/*standards/statistics & numerical data
MH  - Retrospective Studies
FIR - Barclay, Peter
IR  - Barclay P
FIR - Koh, Yvonne
IR  - Koh Y
FIR - Teo, Juliana
IR  - Teo J
FIR - Tantsis, Esther M
IR  - Tantsis EM
FIR - Ramanathan, Sudarshini
IR  - Ramanathan S
FIR - Webster, Richard
IR  - Webster R
EDAT- 2016/06/01 06:00
MHDA- 2017/05/11 06:00
CRDT- 2016/06/01 06:00
PHST- 2016/04/09 00:00 [accepted]
PHST- 2016/06/01 06:00 [pubmed]
PHST- 2017/05/11 06:00 [medline]
PHST- 2016/06/01 06:00 [entrez]
AID - 10.1111/dmcn.13159 [doi]
PST - ppublish
SO  - Dev Med Child Neurol. 2016 Nov;58(11):1180-1192. doi: 10.1111/dmcn.13159. Epub 
      2016 May 31.