ASHP Midyear: Appropriate Use of High-Cost IVIG Therapy for BK Nephropathy Needs Further Studying

Intravenous immunoglobulin (IVIG) therapy is a high-cost medication, so pharmacists must collaborate closely with health care providers to ensure it is used appropriately for patients with BK nephropathy, according to Ashton Coker, PharmD, PGY 1 resident at the Medical University of South Carolina. The typical IVIG dosage is 2 grams per kilogram administered over multiple days, though additional doses may not be necessary if the BK viral load is cleared. If patients only require a single IVIG dose, it can lead to reduced costs associated with other medications and monitoring. However, future studies are needed to identify the ideal patient population for IVIG therapy in BK nephropathy.

Pharmacy Times: How can IVIG therapy contribute to cost for this patient population?

Ashton Coker: So IVIG therapy is a high cost medication, so it's very important for the pharmacist to collaborate with health care providers in order to determine that it's the most appropriate therapy for the patient, and then once an appropriate patient is identified, IVIG is typically dosed at 2 grams per kilogram divided over multiple days. So in patients that cleared the BK viral load demonstrated in our [medication use evaluation] found that additional doses of IVIG were not typically needed. So if they do clear and only need that 1 dose of the 2 grams per kilogram of IVIG, then costs associated with other medication use and monitoring can be reduced.

Pharmacy Times: What are the potential directions for future research to further investigate the role of IVIG in BK nephropathy?

Coker: Future studies are needed to determine the ideal patient to receive IVIG therapy for BK nephropathy. So these studies should include a large sample size and look at IVIG compared to standard of care, and the patients included should have consistent reduction in immunosuppression and then also not be on any other treatments for BK neuropathy to truly see the effects of IVIG on the BK viral load, and future studies with extended follow up periods will also be beneficial.

Pharmacy Times: Is there anything else you would like to add?

Coker: So IVIG is emerging in many different areas, and it definitely allows for the pharmacist to be involved and in collaboration with many health care professionals, and especially in the transplant population.