Practice

Commentary: Controversies in the Department of Health’s clinical guidelines for immunoglobulin use

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1851 (Published 20 October 2008) Cite this as: BMJ 2008;337:a1851
  1. Penny Fitzharris, clinical immunologist 1,
  2. Miriam Hurst, fellow in clinical immunology1
  1. 1Immunology, Auckland City Hospital, Grafton, Auckland 1023, New Zealand
  1. Correspondence to: P Fitzharris pennyf{at}adhb.govt.nz

    Variable supply, high product costs, and an increasing demand for both established and off-label indications have made the Department of Health’s development of a management programme for intravenous immunoglobulin use in the United Kingdom essential. This programme includes three core elements: a demand management plan,1 clinical guidelines,2 and a national immunoglobulin database.

    Intravenous immunoglobulin is used in over 100 conditions by many different disciplines, and, although there is an adequate evidence base for some indications, this is not the case for many others, even where intravenous immunoglobulin is accepted as the most appropriate treatment. The need for improved clinical trial data is clear, but for rare conditions this is difficult. It is reassuring that feedback from neurologists indicates acceptance that the new national guidelines are similar in content to their existing specialty guidelines,3 but in many areas (such as specific …

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