Right dose, right patient: Clinician-led implementation of a national cross-specialty strategy for immunoglobulin stewardship.

BACKGROUND AND OBJECTIVES: 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-management efforts, with substantial regional variation and prescribing for indications lacking evidence of benefit. This study reports the outcomes of a national, clinician-led Ig stewardship strategy implemented between 2018 and 2025. MATERIALS AND METHODS: National Health Service England introduced a three-part programme comprising a national evidence-based commissioning policy, establishment of 21 Sub-Regional Immunoglobulin Assessment Panels, and enhancement of the National Immunoglobulin Database. The strategy embedded cross-specialty 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. RESULTS: All panels were operational by 2021, reporting improved governance, multidisciplinary collaboration and coordinated responses to supply pressures. Panel-led reviews enabled safe treatment withdrawal or dose reduction in selected long-term patients. Non-evidence-based prescribing declined from 8.5% to 1.7%. National Ig use fell by 12% over the first 5 years 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. CONCLUSION: A nationally coordinated, clinician-led stewardship model based on rigorous evidence-based peer review can reduce inappropriate Ig use, optimise dosing, and improve equity of access while delivering substantial cost savings.