Immunodeficiency: primary or acquired

Poster

Insights: A Quality Improvement Project

Thursday, June 15
5:45 PM - 7:00 PM

Objective: Immune globulin (IG) is indicated for the prevention of recurrent infection in primary immunodeficiency diseases (PIDD) but is occasionally used off-label with uncertain benefit. We performed a retrospective systematic review of clinical documentation for patients treated with IG for a diagnosis of PIDD to determine the quality of supportive evidence for the diagnosis and treatment.


Methods: We collected clinical and laboratory data submitted for insurance approval for patients prescribed IG. Anonymized data was reviewed by a panel of immunologists with expertise in PIDD. Panelists adjudicated diagnosis and appropriateness of therapy.


Results: 147 cases were reviewed: 112 female and 35 male, age range 19 - 81. Mean dosing was 0.49gm/kg monthly (STD 0.23), range 0.12-2 gm/kg. Reviewers found clinical data was frequently lacking detail to support the diagnosis or indication for IG therapy, specifically laboratory data or documented evidence of infection. Reviewers agreed 91 of 147 (62%) patients reviewed had a confirmed PIDD diagnosis with IG therapy appropriate for 61 (41%). Diagnostic concordance between prescribers and reviewers was most discrepant for common variable immune deficiency (CVID) patients, with reviewers identifying 28 cases of CVID compared to 86 identified by prescribers (32%).ÂÂ


Conclusions: Based on case review, expert immunologists found insufficient clinical and laboratory evidence to support IG therapy in 58% of cases reviewed. Improvements in diagnostic evaluation and clinical documentation may ensure IG therapy is secured in patients who require the life-saving therapy while reducing use in patients without PIDD, where the benefit is unproven.

Marc Riedl

Associate Clinical Professor
University of California, San Diego

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    Jason Raasch

    Physician
    Midwest Immunology Clinic

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      Leslie Vaughan

      Senior Vice President, Clinical Programs
      NuFactor Specialty Pharmacy

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        Senior Vice President, Sales
        NuFactor Specialty Pharmacy

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          Joe DiStefano

          Director, Clinical Programs
          NuFactor Specialty Pharmacy

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            Elissa Ritt

            Medical Science Liaison
            NuFactor Specialty Pharmacy

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