Clinical Guidelines for Immunoglobulin Use Welcome Denise O’Shaughnessy

Clinical Guidelines for Immunoglobulin Use Overview of changes Aidan McManus

OUTLINE Where are the guidelines? Major changes to guidelines Minor changes to guidelines

Where are the guidelines?

tics/Publications/PublicationsPolicyAndG uidance/DH_ DH_129617

Audio slide presentations online

Second edition update

Second edition update

Second edition update Major changes 1.Selection criteria for appropriate use of immunoglobulin 2.Efficacy outcomes to assess treatment success 3.Modification of existing indications and inclusion of new indications

Haemophagocytic lymphohistiocytosis – 2008

Total Grams Infused for Haematology Q DiagnosisGrams Used% Of Total Idiopathic thrombocytopenic purpura - adult % Other (Haematology) % Autoimmune thrombocytopenia (see ITP) % Autoimmune haemolytic anaemia % Alloimmune thrombocytopenia - fetal therapy (treatment to the mother) % Idiopathic thrombocytopenic purpura ( >16 years) % Haemophagocytic lymphohistiocytosis/haemophagocytic syndrome % Acquired von Willebrand disease % Post-transfusion hyperhaemolysis (usually in patients with sickle cell disease) % Acquired red cell aplasia due to parvovirus B % Other (Other) % Evans' syndrome % Adult HIV-associated thrombocytopenia % Primary immunodeficiencies - Hypogammaglobulinaemia % Systemic lupus erythematosus with secondary immunocytopenias % Haemolytic uraemic syndrome % Alloimmune thrombocytopenia - neonatal therapy % Haemolytic disease of the fetus and newborn (isoimmune haemolytic jaundice in neonates) %

Australian guideline

Haemophagocytic lymphohistiocytosis – 2011

Second edition update 1.Selection criteria for appropriate use of immunoglobulin 2.Efficacy outcomes to assess treatment success 3.Modification of existing indications and inclusion of new indications

Australian guideline

Haemophagocytic lymphohistiocytosis – 2011

Australian guideline

“The update specifies the outcome(s) measures, but not the degree in improvement of outcome(s) required to constitute treatment success” Commissioners will work with expert clinicians to refine these outcomes to provide defined ‘treatment success’ measures where possible. Efficacy monitoring

Second edition update 1.Selection criteria for appropriate use of immunoglobulin 2.Efficacy outcomes to assess treatment success 3.Modification of existing indications and inclusion of new indications

Immunoglobulin use in haematology 2010 database report

Grouping of diseases under single headings

Changes to the colour-coded prioritisation in the Demand Management Programme Grey to Blue The database review identified two of the top 10 immunoglobulin-using indications as Grey (secondary antibody deficiencies and antibody-mediated rejection following solid organ transplantation). In the previous edition, they were listed under immunosuppressive pharmacotherapy, and separately under some of the haematological malignancies such as CLL, without listing other mature B-cell malignancies such as non-Hodgkin’s lymphoma. These have been revised into a single indication. Antibody-mediated rejection following solid organ transplantation and antibody-incompatible transplantation were reviewed, and a single grouping of ‘Transplantation (solid organ)’ has been introduced and listed as Blue.

Changes to the colour-coded prioritisation in the Demand Management Programme Grey to Blue Acquired von Willebrand disease has now been included with acquired haemophilia, in the general disease grouping of ‘Coagulation factor inhibitors’. Polymyositis and Inclusion body myositis have now been grouped with dermatomyositis under the general disease grouping of inflammatory myopathies, with strict selection criteria. Post-transfusion hyperhaemolysis has now been grouped under the more general heading of haemolytic anaemia. SLE with secondary immunocytopenias should be considered under the relevant immune cytopenia.

Changes to the colour-coded prioritisation in the Demand Management Programme Blue to Red Specific antibody deficiency, as a recognised primary antibody deficiency disorder, has been reclassified as a Red indication (for those cases where immunoglobulin replacement therapy is required). Haemolytic disease of the newborn has been updated to reflect recommendations in ‘NICE clinical guideline 98’ on neonatal jaundice.

Second edition update Minor changes 1.Definitions of duration of immunoglobulin treatment 2.Recommended dosing of immunoglobulin 3.Ideal body weight-adjusted dosing of immunoglobulin

Definitions of duration of immunoglobulin treatment

Recommended dosing of immunoglobulin

Ideal body weight-adjusted dosing of immunoglobulin

Database update will reflect advice and updated terminology