Access and use of immunoglobulins in supportive cancer care: A thematic analysis of a systematic review data set

Muireann Counihan; Larisa Cervenakova; Dominika Misztela; Maarten Van Baelen; Bernard D Naughton

doi:10.1177/27550834241236596

Access and use of immunoglobulins in supportive cancer care: A thematic analysis of a systematic review data set

J Med Access. 2024 Mar 28:8:27550834241236596. doi: 10.1177/27550834241236596. eCollection 2024 Jan-Dec.

Authors

Muireann Counihan¹, Larisa Cervenakova², Dominika Misztela³, Maarten Van Baelen³, Bernard D Naughton^{1

4}

Affiliations

¹ School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, University of Dublin, Dublin, Ireland.
² Plasma Protein Therapeutics Association, Annapolis, MD, USA.
³ Plasma Protein Therapeutics Association, Brussels, Belgium.
⁴ Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, Kings College London, Franklin-Wilkins Building, London, UK.

Abstract

Background: Secondary immunodeficiency (SID) disorders are known to occur in patients with haematological malignancies (HM) due to immunosuppressive treatments. Recurring infections causing subsequent morbidity and mortality commonly occur in this patient cohort. Immunoglobulin replacement therapy (IgRT) benefits patients with primary antibody deficiencies. However, evidence supporting their therapeutic role is not as explicit in SID-associated antibody deficiencies, which raises the questions regarding its use in SID and the knock-on effects of this use on its access and availability more generally.

Objectives: This study aimed to learn about the use of immunoglobulins in SID, identify themes concerning its use and access and suggest methods for improving access.

Design: This study included a thematic analysis of a published data set of 43 articles concerning immunoglobulin use and access in SID.

Data sources and methods: The data set used to perform the thematic analysis is based on research articles identified from Excerpta Medica Database (EMBASE) and PubMed databases, published as part of a systematic review and part 1 of this two-part publication series.

Results: A thematic synthesis was conducted to identify recurrent themes. The three primary themes included (1) the context for IgRT prescription, which included patient characteristics and cost burden of IgRT administration, and its use in different countries; (2) factors contributing to inappropriate IgRT use, including health care professionals' awareness of IgRT, disparity between guidelines and actual clinical practice, and the effect of shortages on prescription and chemotherapy-induced hypogammaglobulinemia (HGG); and (3) measures identified to improve IgRT use and access, which included multidisciplinary involvement, improved diagnostic tools and safer withdrawal and stewardship protocols.

Conclusions: IgRT use is increasing in HM as a supportive therapy but without comprehensive clinical guidelines and appropriate prescribing recommendations, medication wastage may occur with consequences for immunoglobulin access.

Keywords: Immunoglobulin; access; supportive cancer care; systematic review; use.

Plain language summary

Access and Use of Immunoglobulins in Supportive Cancer Care: A Thematic Analysis of a Systematic Review Data Set This study covers the use of immunoglobulins in SID, identifies themes concerning its use and access and suggests ways for improving both using a thematic analysis approach. The study identified that IgRT use is increasing in haematological malignancies as a supportive therapy but without comprehensive clinical guidelines and appropriate prescribing recommendations, medication wastage may occur with consequences for immunoglobulin access.