Canada's per capita use of
intravenous immune globulin (
IVIG) grew by approximately 115% between 1998 and 2006, making Canada one of the world's highest per capita users of
IVIG. It is believed that most of this growth is attributable to off-label usage. To help ensure
IVIG use is in keeping with an evidence-based approach to the practice of medicine, the National Advisory Committee on Blood and Blood Products (NAC) and Canadian Blood Services convened a panel of national experts to develop an evidence-based practice guideline on the use of
IVIG for neurologic conditions. The mandate of the expert panel was to review evidence regarding use of
IVIG for 22 neurologic conditions and formulate recommendations on
IVIG use for each. A panel of 6 clinical experts, one expert in practice guideline development and 4 representatives from the NAC met to review the evidence and reach consensus on the recommendations for the use of
IVIG. The primary sources used by the panel were 2 recent evidence-based reviews. Recommendations were based on interpretation of the available evidence and, where evidence was lacking, consensus of expert clinical opinion. A draft of the practice guideline was circulated to neurologists in Canada for feedback. The results of this process were reviewed by the expert panel, and modifications to the draft guideline were made where appropriate. This practice guideline will provide the NAC with a basis for making recommendations to provincial and territorial health ministries regarding
IVIG use management. Recommendations for use of
IVIG were made for 14 conditions, including
acute disseminated encephalomyelitis, chronic inflammatory demyelinating
polyneuropathy,
dermatomyositis,
diabetic neuropathy,
Guillain-Barré syndrome,
Lambert-Eaton myasthenic syndrome, multifocal motor neuropathy,
multiple sclerosis,
myasthenia gravis,
opsoclonus-myoclonus,
pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections,
polymyositis, Rasmussen's
encephalitis, and
stiff person syndrome;
IVIG was not recommended for 8 conditions including
adrenoleukodystrophy, amyotropic
lateral sclerosis,
autism,
critical illness polyneuropathy,
inclusion body, myositis, intractable childhood
epilepsy, paraproteinemic neuropathy (
IgM variant), and
POEMS syndrome. Development and dissemination of evidence-based clinical practice guidelines may help to facilitate appropriate use of
IVIG.