PMID- 29028117
OWN - NLM
STAT- MEDLINE
DCOM- 20180807
LR  - 20191210
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 37
IP  - 12
DP  - 2017 Dec
TI  - Comparison of Weight-Based Dosing Strategies for Intravenous Immunoglobulin in 
      Patients with Hematologic Malignancies.
PG  - 1530-1536
LID - 10.1002/phar.2047 [doi]
AB  - STUDY OBJECTIVE: Intravenous immunoglobulin (IVIG) is a weight-based therapy used 
      to treat and prevent infections in patients with hematologic malignancies. IVIG 
      doses were calculated traditionally using actual body weight (ABW). However, 
      limited pharmacokinetic data suggest dosing strategies using ideal body weight 
      (IBW) or adjusted body weight (adjBW) may be appropriate given the small volume 
      of distribution of IVIG. Our objective was to compare the effectiveness of using 
      a precision-dosing strategy (IBW or adjBW) with a traditional-dosing strategy 
      (ABW) for IVIG in patients with hematologic malignancies or those undergoing 
      hematopoietic stem cell transplant, as well as to perform an IVIG drug use 
      analysis. DESIGN: Retrospective cohort study. SETTING: Academic medical center. 
      PATIENTS: Between April 2014 and September 2016, 209 IVIG encounters met 
      inclusion criteria for the primary outcome. Of those encounters, 125 were dosed 
      using the traditional-dosing strategy, and 84 used the precision-dosing strategy. 
      MEASUREMENTS AND MAIN RESULTS: The primary outcome was infection rate within 
      30 days of IVIG administration. Secondary outcomes included 60-day infection 
      rate, immunoglobulin G (IgG)-level response (IgG higher than 400 mg/dl), and 
      realized and potential IVIG savings. No difference in 30-day infection rate 
      between precision- and traditional-dosing strategies was identified (15.5% vs 
      16%, respectively, p=0.823). Similarly, no difference was identified in the 
      60-day infection rate between groups (23.2% vs 19.8%, respectively, p=0.568). 
      Levels of IgG obtained after IVIG repletion showed a treatment response rate of 
      86% in both groups. Use of a precision-dosing strategy achieved $2600/month in 
      institutional savings with the opportunity for an additional $4600/month in 
      savings with complete adherence to this dosing strategy. CONCLUSION: No 
      differences in infection rate and IgG-level response were identified when a 
      precision-dosing strategy was used. Implementation of an IVIG precision-dosing 
      strategy provided institutional cost savings.
CI  - (c) 2017 Pharmacotherapy Publications, Inc.
FAU - Stump, Sarah E
AU  - Stump SE
AD  - Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, 
      North Carolina.
FAU - Schepers, Allison J
AU  - Schepers AJ
AD  - Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, 
      North Carolina.
FAU - Jones, Alexis R
AU  - Jones AR
AD  - Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, 
      North Carolina.
FAU - Alexander, Maurice D
AU  - Alexander MD
AD  - Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, 
      North Carolina.
FAU - Auten, Jessica J
AU  - Auten JJ
AUID- ORCID: 0000-0001-5461-0064
AD  - Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, 
      North Carolina.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20171127
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Bone Marrow Transplantation/methods
MH  - Drug Costs
MH  - *Drug Dosage Calculations
MH  - Female
MH  - Hematologic Neoplasms/blood/*drug therapy
MH  - Humans
MH  - Immunoglobulins, Intravenous/*administration & dosage/blood/economics
MH  - Infections/drug therapy/epidemiology
MH  - Male
MH  - Middle Aged
MH  - North Carolina/epidemiology
MH  - Retrospective Studies
OTO - NOTNLM
OT  - bone marrow transplantation
OT  - hematologic malignancy
OT  - hypogammaglobulinemia
OT  - intravenous immunoglobulin
EDAT- 2017/10/14 06:00
MHDA- 2018/08/08 06:00
CRDT- 2017/10/14 06:00
PHST- 2017/10/14 06:00 [pubmed]
PHST- 2018/08/08 06:00 [medline]
PHST- 2017/10/14 06:00 [entrez]
AID - 10.1002/phar.2047 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2017 Dec;37(12):1530-1536. doi: 10.1002/phar.2047. Epub 2017 Nov 
      27.