Result card

  • ETH11: How are technologies with similar ethical issues treated in the health care system?
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How are technologies with similar ethical issues treated in the health care system?

Authors: Plamen Dimitrov, Anelia Koteva

Internal reviewers: Pseudo99 Pseudo99

Intravenous immunotherapy is used in a number of diseases, being the only possible alternative in the treatment of primary immunodeficiency conditions (agammaglobulinemia and hypogammaglobulinemia) and secondarily acquired immunodeficiencies. Another major category of pathologies treated successfully with these blood products comprises the following autoimmune diseases: idiopathic thrombocytopenic purpura, Kawasaki disease, chronic inflammatory demyelinating polyneuropathy, Guillain-Barré syndrome, multifocal motor neuropathy, myasthenia gravis, relapsing-remitting multiple sclerosis as well as other autoimmune disorders: pemphigus, autoimmune uveitis, Graves ophthalmopathy, polymyositis, dermatomyositis, etc. The third class of diseases, in which intravenous infusions have proved their therapeutic effect, are acute infectious diseases.

 

IVIG production for therapeutic purposes requires vast resources of blood plasma, for the preparation of which are necessary from 3000 to 10000-20000 healthy blood donors.[1] Unreasonable use of immunoglobulins may result in a rapid depletion of quantities produced, depriving a number of patients of the only available treatment for their disease. So as to   distribute and use most efficiently the limited supplies of immunoglobulins in compliance with the ethical principles of justice and interdependence, some countries have established registries regulating the diseases for which IVIG therapy is deemed routine, namely immunodeficiencies in infants and children and diseases with the only possible alternative immunotherapy whose positive effect has been proven in controlled trials. The choice of method should furthermore be consistent with factors, such as patient’s age, opportunities for peripheral venous access, presence of comorbidities (cardiovascular disorders, a history of allergy or renal disease), which may restrict IVIG administration due to expected complications.[2]

 

Since IVIG administration in AD patients is still at an experimental stage and marked by contradictory intermediate outcomes for the time being, the redirection of the limited quantities of the present blood product to the priority treatment of the huge and rising number of patients with Alzheimer’s disease is likely to disturb the routine therapy of the persons suffering from the  aforementioned autoimmune diseases, which lack another available alternative treatment strategy. Therefore, IVIG administration in AD subjects must not be a first therapeutic choice, whereas each country, depending on the financial capacity of its healthcare system, the available resources of immunoglobulins as well as the number of patients with immunodeficiency conditions and autoimmune diseases, for which no other alternative treatment exists, should determine as to whether to include passive intravenous immunotherapy among the therapies recommended for other groups of diseases (including Alzheimer’s disease).

 

 

[1] Gómez-Puerta, J.A., R. Cervera and J. Font, “Clinical Utility of Intravenous Immunoglobulins in Autoimmune Diseases (Utilidad Clínica de las Inmunoglobulinas Endovenosas en las Enfermedades Autoinmunes)”, Inmunología, vol. 22 /Núm 3/Julio-Septiembre 2003: 287-293, Spain. ; Kaveri, S.-V., G. Dietrich, V. Hurez and M. D. Kazatchkine, “Intravenous Immunoglobulins (IVIg) in the Treatment of Autoimmune Diseases”, Clinical and Experimental Immunology (1991) 86, 192-198, available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2249.1991.tb05794.x/pdf .

[2] Koski, C.L., J.V. Patterson, “Intravenous Immunoglobulin Use for Neurologic Diseases”, Journal of Infusion Nursing, volume 29, number 3 – supplement, pp. S21-S28, June 2006, available at: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=663755 .

Dimitrov P, Koteva A Result Card ETH11 In: Dimitrov P, Koteva A Ethical analysis In: Jefferson T, Cerbo M, Vicari N [eds.]. Use of Intravenous immunoglobulins for Alzeheimer’s disease including Mild Cognitive Impairment [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 31 October 2020]. Available from: http://corehta.info/ViewCover.aspx?id=267