134 Chapter 3 Supplementary Tables 2-4 provide comparative descriptions regarding transformational factors and its effects from the scoping review and interviews. Supplementary Table 2: Factors that could increase Ig demand From literature From interviews Social factors • Aging population who become diseased and need treatments (especially for secondary care) and • Increasing weight (as IVIG is weightbased) • Older age of pregnant women • Growth of population with chronic diseases • Growing aging population who become diseased and need treatments • No age limits for stem cell transplantations • Increasing physician awareness to diagnose patients and prescribe Ig through education, diagnostic tools, or using algorithms embedded in electronic patient record systems • Increasing physician awareness through experience and word of mouth: physicians who used Ig beneficially for patients and mentoring other physicians to do the same Technological/ clinical • Increased secondary immunodeficiency (from increased immune modulating and cellular therapies) • Consequences of CAR-T cell therapy, which may cause prolonged hypogammaglobulinaemia • Consequences of Rituximab therapy • Improved diagnostics for PID • If oncology protocols all harmonized with using Ig suppletion after oncological treatments • Using an algorithm to identify potential patients in medical records • Improved (a-fucosylated) IG • Consequences of anti Fc-Rn antibodies therapy • Increasing complications or consequences from other immunosuppressive treatments, including stem cell transplantations, cellular therapies, new drugs which need IG as secondary support • Pediatric trial (IPAD) in Netherlands to assess if increased Ig dosage will prevent pulmonary diseases and lead to improved outcomes in • patients with PIDs Legal • EMA Guidelines 2019: revisions to the Summary of Product Characteristics (SmPC) which now include CIDP, MMN, and broader definition for secondary immune deficiencies
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