{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T01:06:22Z","timestamp":1790211982572,"version":"4.1.0"},"reference-count":12,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vox Sanguinis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Global demand for immunoglobulin (Ig) continues to rise, driven by expanding clinical indications and limited plasma supply. In England, use increased annually despite earlier demand\u2010management efforts, with substantial regional variation and prescribing for indications lacking evidence of benefit. This study reports the outcomes of a national, clinician\u2010led Ig stewardship strategy implemented between 2018 and 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>National Health Service\u00a0England introduced a three\u2010part programme comprising a national evidence\u2010based commissioning policy, establishment of 21 Sub\u2010Regional Immunoglobulin Assessment Panels, and enhancement of the National Immunoglobulin Database. The strategy embedded cross\u2010specialty clinical review, standardised approval processes, strengthened dosing guidance and improved national data capture. Outcomes were assessed through national audits, retrospective studies and analysis of usage trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All panels were operational by 2021, reporting improved governance, multidisciplinary collaboration and coordinated responses to supply pressures. Panel\u2010led reviews enabled safe treatment withdrawal or dose reduction in selected long\u2010term patients. Non\u2010evidence\u2010based prescribing declined from 8.5% to 1.7%. National Ig use fell by 12% over the first 5\u2009years and, despite a recent increase in demand, Ig use in England in 2025 was almost half of the projected use had the stewardship strategy not been implemented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A nationally coordinated, clinician\u2010led stewardship model based on rigorous evidence\u2010based peer review can reduce inappropriate Ig use, optimise dosing, and improve equity of access while delivering substantial cost savings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/vox.70373","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:26:33Z","timestamp":1790209593000},"source":"Crossref","is-referenced-by-count":0,"title":["Right dose, right patient: Clinician\u2010led implementation of a national cross\u2010specialty strategy for immunoglobulin stewardship"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5453-4927","authenticated-orcid":false,"given":"Claire","family":"Bethune","sequence":"first","affiliation":[{"name":"Peninsula Department of Allergy and Immunology University Hospitals Plymouth  Plymouth UK"},{"name":"University of Plymouth  Plymouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3174-6027","authenticated-orcid":false,"given":"Michael P.","family":"Lunn","sequence":"additional","affiliation":[{"name":"Centre for Neuromuscular Disease National Hospital for Neurology and Neurosurgery  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Foster","sequence":"additional","affiliation":[{"name":"Medical Data Solutions and Services  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Hollingsworth","sequence":"additional","affiliation":[{"name":"Medical Data Solutions and Services  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9245-3115","authenticated-orcid":false,"given":"Darryn","family":"Boardman","sequence":"additional","affiliation":[{"name":"NHS England  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1525-8795","authenticated-orcid":false,"given":"Siraj A.","family":"Misbah","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology Oxford University Hospitals NHS Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/vox.13593"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.18031"},{"key":"e_1_2_9_4_1","unstructured":"NHS England.Commissioning criteria for the use of therapeutic immunoglobulin in England 2025. Available from:https:\/\/www.england.nhs.uk\/wp\u2010content\/uploads\/2021\/12\/ccp\u2010for\u2010the\u2010use\u2010of\u2010therapeutic\u2010immunoglobulin\u2010england\u20102025.pdf. Last accessed 8 Sep 2026."},{"key":"e_1_2_9_5_1","volume-title":"IG database \u2013 National Immunoglobulin Database","author":"MDSAS","year":"2026"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2020-207037"},{"key":"e_1_2_9_7_1","first-page":"e1","article-title":"A single 1 g\/kg dose of intravenous immunoglobulin is a safe and effective treatment for immune thrombocytopenia: results of the first HaemSTAR \u2018Flash\u2010Mob\u2019 retrospective study incorporating 961 patients","volume":"195","author":"HaemSTAR Collaborators","year":"2021","journal-title":"Br J Haematol"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.17328"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18910"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jns.70007"},{"key":"e_1_2_9_11_1","first-page":"843","article-title":"Risk of Guillain\u2010Barr\u00e9 syndrome after COVID\u201019 vaccination in the UK: a self\u2010controlled case series analysis","volume":"145","author":"Patone M","year":"2022","journal-title":"Brain"},{"key":"e_1_2_9_12_1","unstructured":"Marketing Research Beareau.Data and analysis of immunoglobulin supply and plasma requirements in Europe 2010\u20132021. Available from:https:\/\/marketingresearchbureau.com\/wp-content\/uploads\/2023\/05\/MRB_EU_SOHO_Figures1.pdf. Last accessed 18 Mar 2026."},{"key":"e_1_2_9_13_1","unstructured":"National report on the issue and use of immunoglobulin (IG) annual report. Available from:https:\/\/www.blood.gov.au\/sites\/default\/files\/documents\/2025\u201006\/Report%20on%20the%20Issue%20and%20Use%20of%20Ig%202023\u201024.pdf. Last accessed 18 Mar 2026."}],"container-title":["Vox Sanguinis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/vox.70373","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/vox.70373","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/vox.70373","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:26:35Z","timestamp":1790209595000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/vox.70373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":12,"alternative-id":["10.1111\/vox.70373"],"URL":"https:\/\/doi.org\/10.1111\/vox.70373","archive":["Portico"],"relation":{},"ISSN":["0042-9007","1423-0410"],"issn-type":[{"value":"0042-9007","type":"print"},{"value":"1423-0410","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]},"article-number":"vox.70373"}}