Five Fast Facts About IVIG

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Introduction

Despite its importance in treating several immunological and inflammatory conditions, IVIG is a medication that many pharmacists know little about. By functioning as an antibody replacement therapy, IVIG can be used to manage a wide range of inflammatory and autoimmune disorders. Some of IVIG’s indications include primary immune deficiency disorders, Gillian-Barre syndrome, Kawasaki disease, chronic inflammatory demyelinating polyneuropathy, systemic lupus erythematosus, and rheumatoid arthritis.¹

Fact 1: Formulation differences exist among IVIG products (see Table 1^2-6). Some products contain stabilizers such as sucrose, polysorbate, or L-proline, and pharmacists need to be aware of the content.⁷ These differences can change a person’s ability to tolerate the immune globulin and could warrant switching to another therapy.⁸

Table 1. IVIG Products and Clinical Pearls^2-6

Fact 2: Fc receptor binding is a crucial mechanism of action that allows IVIG to exert its immunomodulatory effects.⁹ For patients with primary immunodeficiency disorders, IVIG provides antibodies that their immune system cannot produce. For patients with autoimmune conditions, IVIG bolsters patients’ immune responses and reduces inflammation by decreasing production of pro-inflammatory cytokines.^9,10

Fact 3: IVIG can be challenging to access. Its intricate manufacturing process makes IVIG one of the most expensive therapeutic agents. This process involves compiling and processing plasma from thousands of donors. The cost of a treatment course can range from $5,000 to $10,000 depending on the indication and the patient’s weight-based requirements.⁸ Additionally, IVIG’s growing number of indications has also contributed to the increase in demand and, subsequently, the increase in price.¹¹

Pharmacies have experienced IVIG shortages.¹ The manufacturing process requires a supply of plasma donations,¹⁰ but the increasing number of patients who are benefitting from IVIG is steadily outpacing the supply of plasma donations. A few other factors contributing to IVIG shortages include expanding off-label use of IVIG and growing recognition of conditions that can be improved using IVIG.¹²

Storing IVIG properly is critical to maintain effectiveness and safety. Pharmacies need to store IVIG at temperatures between 2o and 8o C and never freeze it.⁸ Pharmacists play a critical role in ensuring proper storage conditions are managed through the supply chain.¹

Fact 4: Flu-like symptomsare common adverse effects of IVIG infusions, such as headache, fever, and fatigue.¹² Pharmacists can play a key role in educating patients about these potential adverse effects, helping to prepare them for treatment. Pharmacists can also advise patients on managing these effects, such as with OTC pain medications.

YouTube is a frequent source of information for many patients, including those receiving IVIG. Health care professionals need to find reliable videos, however, so that they can recommend the most accurate of videos to patients. Table 2¹⁰ provides tips to find the best YouTube help.

Table 2. Tips to Best Utilize YouTube¹⁰

Fact 5: Frequent administration of IVIG can be burdensome for patients. They may have to visit an infusion center every 3 to 4 weeks for administration, which is time-consuming.⁹ Inform patients that in addition to the slow infusion, they will need to have their vital signs monitored routinely during the infusion, in addition to observation for an hour after the infusion is complete. How often patients need infusions will depend on their condition and treatment response.⁹

Conclusion

IVIG is a complex and invaluable therapeutic agent with a wide range of therapeutic applications in immunology and other medical specialties. Because of its versatility, understanding the indications, storage requirements, cost, and supply chain challenges is vital. Because they are the most accessible providers, pharmacists should also have a baseline understanding of IVIG so that they can best educate and assist patients.

References

1. VB Arumugham, Rayi A. Intravenous Immunoglobulin (IVIG). In: StatePearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. https://www.ncbi.nlm.nih.gov/books/NBK554446/

2. Asceniv [package insert]. ADMA Biologics Incorporated; 2019.

3. Bivigam [package insert]. ADMA Biologics Incorporated; 2012.

4. Gammunex-C [package insert]. Grifols Therapeutics Incorporated; 2003.

5. Hizentra [package insert]. CSL Behring AG Switzerland; 2010.

6. Privigen [package insert]. CSL Behring AG Switzerland; 2007.

7. Katz J. Intravenous Immunoglobulin. MedScape. Updated April 21, 2023. Accessed July 29, 2024. https://emedicine.medscape.com/article/210367-overview

8. Vaughan LJ. Managing cost of care and healthcare utilization in patients using immunoglobulin agents. Am J Manag Care. 2019;25(6 Suppl):S105-S111.

9. Intravenous Immunoglobulin (IVIG). Versus Arthritis. Accessed July 29, 2024. https://versusarthritis.org/about-arthritis/treatments/drugs/intravenous-immunoglobulin-ivig/

10. Madathil KC, Rivera-Rodriguez AJ, Greenstein JS, Gramopadhye AK. Healthcare information on YouTube: a systematic review. Health Informatics J. 2015;21(3):173-194. doi:10.1177/1460458213512220

11. Runken MC, Noone JM, Blanchette CM, Zacherle E, Howden R. Differences in patient demographics and healthcare costs of patients with PIDD receiving intravenous or subcutaneous immunoglobulin therapies in the United States. Am Health Drug Benefits. 2019;12(6):294-304.

12. Afonso AFB, João CMP. The production processes and biological effects of intravenous immunoglobulin. Biomolecules. 2016;6(1):15. doi:10.3390/biom6010015