Right dose, right patient: Clinician-led implementation of a national cross-specialty strategy for immunoglobulin...

Global demand for immunoglobulin (Ig) continues to rise, driven by expanding clinical indications and limited plasma supply. In England, use increased annually despite earlier demand-management efforts, with substantial regional variation and prescribing for indications lacking evidence of benefit. This study reports the outcomes of a national, clinician-led Ig stewardship strategy implemented between 2018 and 2025.

National Health Service England introduced a three-part programme comprising a national evidence-based commissioning policy, establishment of 21 Sub-Regional Immunoglobulin Assessment Panels, and enhancement of the National Immunoglobulin Database. The strategy embedded cross-specialty clinical review, standardised approval processes, strengthened dosing guidance and improved national data capture. Outcomes were assessed through national audits, retrospective studies and analysis of usage trends.

All panels were operational by 2021, reporting improved governance, multidisciplinary collaboration and coordinated responses to supply pressures. Panel-led reviews enabled safe treatment withdrawal or dose reduction in selected long-term patients. Non-evidence-based prescribing declined from 8.5% to 1.7%. National Ig use fell by 12% over the first 5 years and, despite a recent increase in demand, Ig use in England in 2025 was almost half of the projected use had the stewardship strategy not been implemented.

A nationally coordinated, clinician-led stewardship model based on rigorous evidence-based peer review can reduce inappropriate Ig use, optimise dosing, and improve equity of access while delivering substantial cost savings.