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基于5年期间免疫球蛋白G的临床使用数据,波兰原发性免疫缺陷患者获得免疫球蛋白替代疗法的机会增加。

Increased Access to Immunoglobulin Replacement Therapy for Patients with Primary Immunodeficiency in Poland Based on Clinical Usage Data of Immunoglobulin G over a 5-Year Period.

作者信息

Więsik-Szewczyk Ewa, Ziętkiewicz Marcin, Radziwilska-Muc Anna, Jahnz-Różyk Karina

机构信息

Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, 04-349 Warsaw, Poland.

Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland.

出版信息

J Clin Med. 2023 Mar 22;12(6):2431. doi: 10.3390/jcm12062431.

Abstract

Owing to the rising popularity and demand for immunoglobulins (IgG), obtaining supplies and rationalizing IgG use have become challenging. Herein, IgG consumption in Poland was analyzed through total IgG use and number of patients reported to the National Health Fund between 1 January 2016 and 31 December 2020. Total IgG used within 5 years increased by 27.48%, IgG use/1000 inhabitants/year was 23.13 g (2016) and 29.61 g (2020). In 2020, 35.5 % of IgG used was for neurological conditions, 25% for primary immunodeficiencies (PID), and 39.3% for all other indications. Within 5 years, 1,121,168.75 g IgG was used in PID; the use increased by 72%, from 783 in 2016 to 1153 patients in 2020. The proportion of patients who received subcutaneous immunoglobulin (SCIG) replacement therapy (IgRT) increased to 78% (2020). Within 5 years, 1,783,534.81 g IgG was used in neurological drug programs (+42.44%) and 2,327,513.88 g (+1.25%) outside neurological indications and outside PID. The annual IgG amount decreased in adult anesthesiology and intensive care (-46%), internal medicine (-55%), pneumonology (-50%), pediatric clinical immunology (-50%), and gynecology and obstetrics (-48%) and increased in dermatology (+178%), rheumatology (+103%), and clinical transplantation (+82%). IgG use significantly increased in Poland, mostly owing to PID. Subcutaneous IgG administration is currently the most common mode of IgRT in PID patients. An increase in SCIG administration may be expected for other indications. Implementing evidence-based clinical guidelines is key to prioritizing and rationalizing IgG use for immunomodulatory indications and secondary immune deficiencies.

摘要

由于免疫球蛋白(IgG)的受欢迎程度和需求不断上升,获取供应品以及合理使用IgG变得具有挑战性。在此,通过2016年1月1日至2020年12月31日期间波兰的总IgG使用量以及向国家卫生基金报告的患者数量,对波兰的IgG消费情况进行了分析。5年内使用的总IgG增加了27.48%,IgG使用量/每1000居民/年在2016年为23.13克,在2020年为29.61克。2020年,35.5%的IgG用于神经系统疾病,25%用于原发性免疫缺陷(PID),39.3%用于所有其他适应症。5年内,PID患者使用了1,121,168.75克IgG;使用量增加了72%,从2016年的783例患者增加到2020年的1153例患者。接受皮下免疫球蛋白(SCIG)替代疗法(IgRT)的患者比例增加到78%(2020年)。5年内,神经系统药物项目使用了1,783,534.81克IgG(增加42.44%),神经系统适应症和PID之外使用了2,327,513.88克IgG(增加1.25%)。成人麻醉学和重症监护(-46%)、内科(-55%)、肺病学(-50%)、儿科临床免疫学(-50%)以及妇产科(-48%)的年度IgG用量减少,而皮肤科(+178%)、风湿病学(+103%)和临床移植(+82%)的用量增加。波兰的IgG使用量显著增加,主要是由于PID。皮下IgG给药目前是PID患者中最常见的IgRT方式。预计其他适应症的SCIG给药也会增加。实施基于证据的临床指南是对免疫调节适应症和继发性免疫缺陷的IgG使用进行优先排序和合理化的关键。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/786a/10059916/1cb770184b68/jcm-12-02431-g001a.jpg

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