135 Using a scenario approach to assess for the current and future demand of immunoglobulins Supplementary Table 3: Factors that could decrease Ig demand From literature From interviews Social factors • Negative public perceptions due to a blood scandal or negative perception of medicines from human origins Technological/ clinical factors • New products for rheumatologic diseases and increased use of thrombopoietin agonists for immune thrombocytopenia (mentioned in Discussion) • Use of steroids as first-line treatment option in myasthenia gravis • Rituximab therapy, as replacement for IVIG • Lack of sufficient RCTs that prove IVIG’s efficacy • Recombinant products • Alternatives to IVIG, such as biological products, targeted therapies like monoclonal drugs, neonatal receptor (Fc-Rn receptor) blocker that has the same effect as IVIG (blocks the Fc-Rn receptor) but with mechanism differences, or Immunoglobulin G-degrading enzyme of Streptococcus pyogenes (IdeS, a cysteine protease that cleaves IgG antibodies into fragments) • Gene-correcting therapies (gene therapy, stem cell transplantation, CRISPR-Cas) for certain primary immune deficiencies with a monogenetic cause of the disease • Using Rituximab therapy in CIDP patients (trial undergoing) • Studies that explain IVIG’s mechanism to create alternatives to it • RCTs that disprove IVIG’s efficacy in various diseases; specifically, neurology trials for stopping/tapering patients off IVIG (e.g in CIDP) Ecological • Infectious disease transmitted through plasma donations, not detectable through screening Economic/ political/legal • High cost of IVIG • High cost of IVIG • Increased focus on using costeffectiveness in choosing products • Dutch Transfer Act 2021, with the aim of controlling Ig usage • Strictness with off-label IVIG usage • Ethical stance not to harm plasma donors in any way (including for remunerated donations)
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