Pharmacists Are Critical to Proper Management of IVIG for Chronic Inflammatory Demyelinating Polyneuropathy

Pharmacists’ role in managing difficult-to-treat conditions continues to expand as more effective therapeutic options emerge. Chronic inflammatory demyelinating polyneuropathy (CIDP) is one such disorder in which treatment options have grown and collaboration among pharmacists and other members of a patient care team has proven essential, especially regarding the use of intravenous immunoglobulin (IVIG) as a treatment option.

CIDP can cause muscle weakness, tingling sensations, and fatigue. | Image Credit: © Chinnapong | stock.adobe.com

CIDP, a rare inflammatory disorder, can cause progressive numbness and muscle fatigue because of the gradual destruction of the myelin sheath of peripheral nerves roots. Segmental demyelination and remyelination occur, which leads to inflammation in the nerves and causes impaired balance, difficulty completing aspects of a daily routine, and a substantial associated comorbidity burden in patients.^1,2

There is no treatment that can fully resolve CIDP. Yet IVIG, an FDA-approved treatment in which healthy antibodies from plasma donors are infused into the blood of patients, has shown efficacy in providing relief for the everyday symptoms of CIDP preventing serious complications.²

Multiple trials have analyzed IVIG’s efficacy and safety in patients with CIDP. Rm Bus et al conducted a systematic review, most recently updated in 2023, of 9 randomized control trials featuring 372 participants with CIDP. Results indicated that IVIG increases the likelihood of significant disability improvement within 6 weeks of the start of treatment compared with placebo.³

Another study, conducted by researchers at the University of Rochester Medical Center, aimed to evaluate treatment responses in patients with CIDP treated with a variety of therapies, including IVIG. Of the 12 patients who reported symptom improvements based on a series of scales evaluating their treatment response, 11 had received IVIG, which further indicates its therapeutic potential.¹

For pharmacists, choosing the correct IVIG product and the proper dose for a patient is essential. Although there are a dozen FDA-approved brands of IVIG for pharmacists to choose from, patients with CIDP may respond differently to one brand over another, which is critical for a pharmacist to note for future administration.^2,4

Dosing is also important; higher doses of IVIG may be required for patients with more serious CIDP or for those who are unresponsive, but can also lead to more serious treatment-related adverse events (AEs). Following IVIG administration, a range of AEs have been reported, including those that are mild—fever, chills, fatigue—and those that are more serious, such as thromboembolic events or meningitis. In a study analyzing children’s response to IVIG, 39% of patients experienced an IVIG-related AE. Notably, the investigators found that IVIG infusions intended to treat inflammatory conditions had a higher rate of causing an IVIG-related AE than those administered for other reasons, such as plasma replacement therapy.^2,5

It is important for pharmacists to stay aware and up to date on a patient’s IVIG dosing schedule and monitor them for any AEs that may emerge during treatment. Patients should be assured that the administration of IVIG is safe, and pharmacists should observe patients during and following the infusion process, as AEs may emerge immediately or after a period. IVIG may be associated with a higher frequency of serious AEs in patients with CIDP compared with other methods, so pharmacists must be especially cautious during a patient’s treatment course.³

Another factor that pharmacists should consider are patients with CIDP that present to IVIG treatment with a comorbidity. Layton et al conducted a trial to characterize the presentation of patients with CIDP who initiate IVIG and found that diagnoses of comorbidities in the 6 months prior to IVIG administration were frequent. These included neuropathy (75%), hypertension (62%), and diabetes (33%).⁶

Given that patients with CIDP who initiate IVIG often have an associated comorbidity, pharmacists should collaborate with the patient’s care team to clarify any drug contraindications that may be present with IVIG and a medication for a comorbidity. Pharmacists also play a large role in ensuring the continuation of other medications a patient may have for their comorbidities while they are being treated with IVIG, as the arduous course of IVIG treatment may lead to patients skipping or forgetting other prescribed medicines.⁶

CIDP can be a complicated disorder to treat. Luckily, IVIG is an effective option to reduce symptoms when administered appropriately. To ensure patients with CIDP prescribed IVIG receive optimal treatment, pharmacists need to play a central role in setting up the most comfortable infusion schedule and dosing for the patient, monitoring AEs that emerge during treatment, and managing associated comorbidities.

REFERENCES

1. Iyer BR. Treatment benefit for chronic inflammatory demyelinating polyneuropathy observed with intravenous immunoglobulin, corticosteroids. Pharmacy Times. Published August 16, 2024. Accessed January 13, 2025. https://www.pharmacytimes.com/view/treatment-benefit-for-chronic-inflammatory-demyelinating-polyneuropathy-observed-with-intravenous-immunoglobulin-corticosteroids

2. Abacan, DB. IVIG for CIDP. AmeriaPharma SpecialtyCare. Last updated November 22, 2022. Accessed January 13, 2025. https://ameripharmaspecialty.com/other-health-conditions/ivig-for-cidp/

3. Rm Bus S, de Haan RJ, Vermeulen M, et al. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst Rev. 2024;2(2):CD001797. doi:10.1002/14651858.CD001797.pub4

4. FDA. Approved Blood Products—Immune Globulins. Last updated March 8, 2023. Accessed January 13, 2025. https://www.fda.gov/vaccines-blood-biologics/approved-blood-products/immune-globulins

5. Halpern L. Mild IVIG-related adverse events are frequent in children, with serious reactions possible. Pharmacy Times. Published December 24, 2024. Accessed January 13, 2025. https://www.pharmacytimes.com/view/mild-ivig-related-adverse-events-are-frequent-in-children-with-serious-reactions-possible

6. Layton JB, Ritchey ME, Huang Z, et al. Intravenous immunoglobulin initiation in patients with chronic inflammatory demyelinating polyradiculoneuropathy: A US claims-based cohort study. Neurol Ther. 2023;12(4):1171-1186. doi:10.1007/s40120-023-00479-4