6587 Utilization of intravenous immunoglobulin in the paediatric neurology department of a tertiary children’s hospital in the Middle East

Objectives This study aimed to assess the adherence of the neurology department at a tertiary pediatric hospital to international clinical standards concerning intravenous immunoglobulin (IVIg) usage. The impact of simultaneous steroid treatment and the significance of premedication in averting side effects were also evaluated. Methods This was a retrospective analysis carried out at Al Jalila Children's Hospital (AJCH) in UAE. Medical records of patients below 18 years who received IVIg for neurological indications from January 2019 till December 2021 were reviewed. Indications were Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Guillain-Barre Syndrome (GBS), Dermatomyositis, presumed/confirmed autoimmune encephalitis, infectious encephalitis, Acute demyelinating encephalomyelitis (ADEM) and Opsoclonus- Myoclonus-Ataxia Syndrome (OMAS). 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'.¹ Results During the three-year study duration, the neurology department treated 27 patients with IVIg with a total of 43 encounters. Out of these 27 patients, 96% were given IVIg for conditions approved by the NHS (N=26). One encounter involved treating multiple sclerosis with IVIg, a method not endorsed by the NHS. This didn't yield noticeable improvements upon follow up. GBS was the predominant reason for IVIg treatment, accounting for 40% (N=11). With one exception, every patient was given IVIg at 2 g/kg over two days. This practice contrasts with NHS's recommendation of dispensing it over five days for most neurological conditions, except CIDP, which aligns with the two-day regimen. Post-IVIg treatment, 66% of patients (N=18) showed significant improvement within the ensuing few weeks. Of the GBS cases 81% (N=9) exhibited marked recovery using the prescribed dose. Aside from GBS and HHV-6 Encephalitis cases, 85% of the improving cases (N=6 out of 7) had concomitant steroid treatments. Yet, no conclusive evidence points to a combined benefit of steroids and IVIg (p=0.09). Of note, preliminary findings don't validate the benefit of premedication before IVIg to mitigate side effect risks (p=0.47). Conclusion This is the first study in the UAE detailing IVIg utilization in a paediatric population in a neurology service setting. Even with suboptimal alignment with NHS dosing guidelines, favourable outcomes were prevalent in our clinical approach. Emphasizing on GBS, the primary IVIg indication in our study, displayed substantial patient recovery even with a shortened treatment duration against NHS standards. It's clear IVIg holds therapeutic potential for certain neurological ailments, but broader, uniform studies are crucial for treatment comparisons. References Gadian J, Kirk E, Holliday K, Lim M, Absoud M. Systematic review of immunoglobulin use in paediatric neurological and neurodevelopmental disorders. Dev Med Child Neurol. 2017 Feb;59(2):136–144. doi: 10.1111/dmcn.13349. Epub 2016 Nov 30. PMID: 27900773. Korinthenberg R, Schessl J, Kirschner J, Mönting JS. Intravenously administered immunoglobulin in the treatment of childhood Guillain-Barré syndrome: a randomized trial. Pediatrics. 2005 Jul;116(1):8–14. doi: 10.1542/peds.2004-1324. PMID: 15995024. NHS England. (2021). Commissioning Criteria Policy for the use of therapeutic immunoglobulin (Ig).