The increasing use of immunoglobulins (Ig) at worldwide level and laboratory manufacturing problems result in high supply tensions on these drugs. Order quotas are set up by the laboratories to ensure a fixed quantity for each establishment.
Issuing clinical guidelines for Ig uses to limit over-consumption of Ig.
The observatory OBSERVIG framework exists since 2012 and meets twice a year. It consists of one referring doctor for each medical speciality.
During this meeting, an assessment of Ig consumption is complete, off label indication are reassess and good use recommendations are discuss.
Capping doses at 150grams/cure/patient for patients has led to important savings (1kg in 2018 corresponding to 36 000€).
Respect of posology at 0,3g/kg in hematology has led to save 2,5kg in 2018 corresponding to 87 500€.
Regularly reassessment to mesure the efficiency of Ig can lead to decrease doses and reduce the cures frequency for stable patients.
Some indications are reevaluated in nephrology where Ig are reserved to treat acute rejection.
Plasma exchange can be the right solution to preserve stock of Ig in some disorders and in some conditions (availability, urgency degree).
All off label indications must be validated by OBSERVIG to justify the use.
The implementation of local recommendations associated with the investment of the medical teams limited the over-consumption of Ig during this rupture. The preserved stock enable to treat vital emergencies, new patients and to provide them an optimal care.
Caregivers have been sensitized on the proper use of these expensive drugs with a limited stock.