[Indications for immunoglobulins. Recommendations of CEDIT of AP-HP in 2006]

To analyze and coordinate the prescription of IVIg in the university hospitals of the AP-HP, the CEDIT, an administrative office created to study new technologies and innovative drugs prescribed in Paris hospitals, nominated a group of experts in 1992.

The experts were assigned the following tasks: 1) to analyze prescriptions and establish a list of indications of IVIg according to the authorization already accorded by the French Ministry of Health; 2) to stimulate prospective trials and evaluation protocols for promising indications of IVIg; 3) to prepare guidelines to optimize the IVIg regimens for authorized indications; 4) to establish a list of potential indications, based on the scientific literature and clinical experience, which extended beyond those authorized by the French Drug Agency and anticipated new uses. A registry was created in which the data on indications, brands, doses, and numbers of perfusions/patient were recorded. Pharmacists and treating physicians had to fill out forms for each patient and biannually reported the results to the group of experts; problems concerning surveillance of IVIg prescriptions were discussed with them.

Indications were divided into three groups: 1) established (authorized in France and Europe, and widely accepted); 2) not authorized but scientifically accepted or being tested in prospective trials; 3) not recommended. In France, IVIg prescriptions have steadily increased every year since 1991, but oversight by the group of experts has lowered IVIg use in Paris hospitals due to better defined indications.

The coordination of IVIg prescriptions in Paris hospitals resulted in optimization of indications, better adapted guidelines and their improved observance, and more prospective trials for potential indications.