6585 Utilization of intravenous immunoglobulin (IVIg) in a tertiary paediatric hospital in the United Arab Emirates

Objectives To evaluate adherence to international clinical guidelines for the use of intravenous immunoglobulin (IVIg). This research also examines the effects of different IVIg concentrations and the role of pre-medications on the occurrence of adverse reactions. Methods This was a retrospective analysis at Al Jalila Children's Hospital (AJCH) in Dubai, UAE. Electronic health records of all patients aged 0–18 years who received IVIg for various diagnoses between January 2019 and December 2021 were reviewed. Data was transferred to Microsoft Excel and analysed with IBM Statistical Package for the Social Sciences (SPSS) software version 27. Practices were compared to the 'NHS Commissioning Criteria Policy for the use of therapeutic immunoglobulins, 2021'. Results A total of 301 encounters were included. Of these, 80% were administered IVIg for reasons approved by the NHS Policy (N=241). Deviations from the internationally approved indications were observed during the study period and included conditions such as paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), myocarditis, and sepsis (20%, N=60). Adherence to the recommended dosage and frequency guidelines was observed in 75.1% of cases (N=181). Full compliance with the policy was achieved for haematological indications predominantly immune thrombocytopenic purpura, Kawasaki disease, and Pediatric Inflammatory Multisystem Syndrome (PIMS). 73.4% of patients who received IVIg for approved indications showed improvement (N=177). A notable link was discerned between adverse events frequency and IVIg concentration, with a surge in events using human IVIg 10% in comparison to 5% (p = 0.009384). Pre-medications did not significantly alter the adverse reactions rate (p = 0. 004244). Conclusion This is the first study in the UAE detailing IVIg utilization in a tertiary pediatric hospital. The excessive use of IVIg in the UAE persists to be evident. Our local experience confirms that there needs to be on-going education about the clinical indications for IVIgadministration. This is evident with the noted improvement in cases were IVIg was used for approved indications, in comparison to the lack of improvement in the majority of the unapproved indications when usedntriguingly, premedication, including steroids, didn't lessen adverse event occurrences. This warrants further studies to determine the necessity of premedicating patients prior to IVIgadministration. Keeping in mind the availability of resources and supplies, use of IVIg 5% would be encouraged over the use of IVIg10% given that a lower rate of adverse reactions was noted with its use. References Ballow M, Shehata N. Overview of intravenous immune globulin (IVIg) therapy. UpToDate. 2022. https://www.uptodate.com/contents/overview-of-intravenous- immune-globulin-ivig-therapy?search=ivig&source=search_result&selectedTitle=2~148&usage_type=default&display_rank=1. NHS England. (2021). Commissioning Criteria Policy for the use of therapeutic immunoglobulin (Ig). Shehata N, Palda V, Bowen T, Haddad E, Issekutz TB, Mazer B, Schellenberg R, Warrington R, Easton D, Anderson D, Hume H. The use of immunoglobulin therapy for patients with primary immune deficiency: an evidence-based practice guideline. Transfus Med Rev. 2010 Jan;24(Suppl 1):S28–50. doi: 10.1016/j.tmrv.2009.09.011. PMID: 19962579.