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Guidelines on the use of intravenous immune globulin for neurologic conditions.
Transfus Med Rev. 2007 Apr;21(2 Suppl 1):S57-S107.
Feasby T, Banwell B, Benstead T, Bril V, Brouwers M, Freedman M, Hahn A, Hume H, Freedman J, Pi D, Wadsworth L.
IVIG Hematology and Neurology Expert Panels.
Canada's
per capita use of intravenous immune globulin (IVIG) grew by
approximately 115% between 1998 and 2006, making Canada one of the
world's highest per capita users of IVIG. It is believed that most of
this growth is attributable to off-label usage. To help ensure IVIG use
is in keeping with an evidence-based approach to the practice of
medicine, the National Advisory Committee on Blood and Blood Products
(NAC) and Canadian Blood Services convened a panel of national experts
to develop an evidence-based practice guideline on the use of IVIG for
neurologic conditions.
The mandate of the expert panel was to review
evidence regarding use of IVIG for 22 neurologic conditions and
formulate recommendations on IVIG use for each. A panel of 6 clinical
experts, one expert in practice guideline development and 4
representatives from the NAC met to review the evidence and reach
consensus on the recommendations for the use of IVIG. The primary
sources used by the panel were 2 recent evidence-based reviews.
Recommendations were based on interpretation of the available evidence
and, where evidence was lacking, consensus of expert clinical opinion.
A draft of the practice guideline was circulated to neurologists in
Canada for feedback. The results of this process were reviewed by the
expert panel, and modifications to the draft guideline were made where
appropriate. This practice guideline will provide the NAC with a basis
for making recommendations to provincial and territorial health
ministries regarding IVIG use management. Recommendations for use of
IVIG were made for 14 conditions, including acute disseminated
encephalomyelitis, chronic inflammatory demyelinating polyneuropathy,
dermatomyositis, diabetic neuropathy, Guillain-Barre syndrome,
Lambert-Eaton myasthenic syndrome, multifocal motor neuropathy,
multiple sclerosis, myasthenia gravis, opsoclonus-myoclonus, pediatric
autoimmune neuropsychiatric disorders associated with streptococcal
infections, polymyositis, Rasmussen's encephalitis, and stiff person
syndrome; IVIG was not recommended for 8 conditions including
adrenoleukodystrophy, amyotropic lateral sclerosis, autism, critical
illness polyneuropathy, inclusion body, myositis, intractable childhood
epilepsy, paraproteinemic neuropathy (IgM variant), and POEMS syndrome.
Development and dissemination of evidence-based clinical practice
guidelines may help to facilitate appropriate use of IVIG.
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