Immunology

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What to Expect from Intravenous Immunoglobulin (IVIG) Therapy

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What is intravenous immunoglobulin (IVIG)?

IVIG is a blood product made from the donated antibodies of between 1,000-15,000 human donors per batch.1 Antibodies are proteins in your body that help fight infection. Your body has different antibodies to fight different infections, like how you have different keys for different locks. If your body does not have enough antibodies or has damaged antibodies, IVIG can help replace them.

Why would I need IVIG?

IVIG may be prescribed for different reasons. The most common reasons include:

  • Immunodeficiency disorders
    • - Primary immunodeficiencies (PID)
    - Common variable immunodeficiency (CVID)
  • Autoimmune disorders
    • - Immune thrombocytopenia (ITP)
    - Autoimmune hemolytic anemia (AIHA)
    - Guillain-Barre syndrome (GBS)
  • Neurologic disorders
    • - Chronic inflammatory demyelinating polyneuropathy (CIDP)
    - Multifocal motor neuropathy (MMN)
    - Myasthenia Gravis
    - Multiple sclerosis (MS)
    - Stiff person syndrome (SPS)
  • Organ transplant
    • - Desensitization
    - Post-transplant maintenance
    - BK virus

What can I expect before starting therapy?

Before starting IVIG therapy your doctor will perform the necessary tests to determine whether IVIG therapy would be a good fit for you. Once you and your doctor make the decision to start IVIG, you will then decide where you will receive your IVIG infusions. Options include a doctor’s office, infusion centers and even your own home.

Before your first infusion, your pharmacist will call you to review your medical history, infusion date and other information for the success of your infusion.

What can I expect the day of infusion?

The day of infusion, you will have a healthcare professional administer your IVIG. IVIG is given through a vein which may be accessed from your arm, a port or PICC line. Your doctor may prescribe pre-medications such as acetaminophen or diphenhydramine to prevent side effects such as headache and infusion reactions.

During your infusion, your nurse or doctor will likely monitor your blood pressure. It is also important to stay hydrated during the infusion, and you may be given IV fluids or be encouraged to drink fluids by mouth. In total your infusion will take between 2 to 4 hours. Remember to have a cell phone, book, or other activity that you can use to relax during the infusion.2

What are the side effects of IVIG?

Like any medication, IVIG is associated with certain side effects. Every patient will experience IVIG differently. You may have no side effects at all, or you may have several side effects. The most common side effects include:

  • Headache (mild-severe)
  • Flu-like symptoms
  • Injection site reactions
  • Feeling tired
  • Blood pressure changes

Seek medical attention immediately if you experience or think you might be experiencing any of the following rare but serious side effects:

  • Renal dysfunction
  • Allergic reaction (hives, swelling of the lips, tongue, or face)
  • Thrombosis, or clotting
  • Aseptic meningitis (severe headache, confusion, stiff neck, fever, fatigue)

Your doctor and pharmacist are there to help make IVIG as safe and comfortable as possible. If any side effect is troubling you, start a conversation. They may be able to slow the infusion rate to help reduce side effects or offer ways to help side effects such as over the counter pain relievers or cold/warm packs for infusion site reactions.3

How should I store IVIG?

IVIG should be stored in the refrigerator. The best place is in the middle of the fridge. Avoid the back of the fridge where it may be colder and the door, where it may be warmer. Do NOT heat, freeze, or shake your IVIG medication.3

Can I get immunizations while on IVIG?

Immunizations may not work as well while on IVIG. If possible, it is recommended to receive your vaccines prior to beginning your IVIG therapy. Talk to your doctor about the best vaccine schedule for you.2

More questions?

Contact your doctor or pharmacist! This article and others are not a replacement for the direct advice of your doctor or pharmacist. It is important for you to feel confident and comfortable with your infusion. Your health care team is there to help.

BioMatrix is proud to make a difference in the communities we serve, one patient at a time.

Our clinicians and support staff offer a tailored approach to every therapeutic category, improving quality of life for patients and producing positive outcomes along the healthcare continuum. Learn more.

References

  1. Jolles S, Sewell WA, Misbah SA. Clinical uses of intravenous immunoglobulin. Clin Exp Immunol. 2005 Oct;142(1):1-11. doi: 10.1111/j.1365-2249.2005.02834.x. PMID: 16178850; PMCID: PMC1809480.

  2. Silvergleid A. Intravenous immune globulin ivig beyond-the-basics [Internet]. UpToDate. 2020 [cited 2020Jun23]. Available from: https://www.uptodate.com/contents/intravenous-immune-globulin-ivig-beyond-the-basics

  3. Lexi-Drugs. [cited 2020 June 23] In Lexicomp Online [Internet]. Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc. Available from:Available from: http://online.lexi.com.

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Three Simple Ways Medical Providers Can Improve Therapy Adherence

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Filled prescriptions that lay wasting in pill boxes and bottles do nothing for patients while costing payers $ billions each year. No one can ‘make’ people stick to their treatment plans. The answer to “are you taking your medications?” is usually “yes.” But the statistics tell us that “yes” often means “sometimes” or “no”. And while it’s common to embellish lifestyle choices to our healthcare provider (i.e. when 1-3 drinks per week really means 5-7), not adhering to a prescribed treatment plan is a big deal. And can be very dangerous.

Data shows that in 2018, over 3.7 billion retail and mail order prescription drugs were filled at pharmacies by payers costing them over $510 billion.(1) And only 30% to 50% of drugs were being taken as prescribed. In other words, roughly $250 billion worth of drugs had 0 impact and were thrown away. The scariest part is that roughly two-thirds of those (many times life-saving) prescription drugs were intended to treat chronic, many times deadly, disease. (2) 

Used to treat chronic, more complex conditions, specialty drugs are especially susceptible to non-adherence and its consequences. While treatment for chronic disease can be cumbersome, time-intensive, and bring about more side-effects, there’s a lot more at stake when, for example, a cancer patient misses their critical dose. While adherence technology (e.g. reminders built into pill boxes and medication sensors) will likely be an important component in the future, nothing replaces personal interactions with patients. Here are three tips for patient interaction to help improve medication adherence. 

Listen and Respond with Empathy

In the face of non-adherence, an obvious question to ask patients is ‘why’. And while that may seem like the first logical question to ask, it can also feel accusatory. 

A recent Pharmacy Times article gives some good advice on how to better spark the adherence topic. This is inline with the “motivational interviewing” method that focuses on decisional balance and internal motivation. For example, instead of starting the conversation with “Why aren’t you taking your medications?” you can rephrase the question as, “Many people have trouble taking their medications on a regular basis. Do you find that this is the case for any of your medications?”3 The phrasing of the second question removes the blame and shame by lending the perspective that many people struggle with taking their medications, it’s not just ‘you’.

When continuing the conversation, it’s easy to instantly get into advice-giving mode before gaining a little more understanding of the patient, especially when they are clearly not following their treatment plan. However, if the patient feels that you’re listening in a non-judgmental way and have some empathy first, they’re more likely to be honest, come to their own conclusions, and be more open to what you have to say. Examples of some questions to guide the conversation include: 

  • Sometimes we get busy and we do not take all the doses of our medicines.

    • How often do you have difficulty remembering to take all your medicines?

  • Taking medication every day is a real inconvenience for some people.

    • Do you ever feel hassled about sticking to your regimen?

    • What gets in the way of taking your medication as prescribed?(3)

Provide Multiple Means of Education for the Patient

To the prescriber and pharmacist, the correlation between following one’s treatment plan and positive outcomes is a given. To the patient who may not be seeing positive results right away (and on the flip side is seeing only the negative—i.e. side effects, high drug costs, and time intensive routines), it may not be so obvious. Especially with specialty drugs, educating the patient beyond just asking “are there any questions with your medication?” encourages adherence. Some ways to do this include:

  • Offer both in-person and online training for self-infusible and injectable medications

  • Provide programs that discuss the importance of therapy adherence and positive self-management

  • Encourage community outreach and support through events and online platforms

Check In Frequently

Similar to New Years Resolutions, we all have intentions of sticking to our plans. But without consistent and frequent accountability, intentions and will-power run dry. An online article published in U.S. Pharmacist, presents multiple studies where increased in-person pharmacist interaction led to increased adherence rates.4 While in-person interactions are typically the most effective, it’s unrealistic that all patients requiring specialty pharmacy drugs are within reasonable range of their physical specialty pharmacy location and/or are even able to get there on a regular basis. The good news is that text messaging has also shown to be effective. The same article cites a study where text messaging doubled the odds of medication adherence and improved overall adherence rates by 17.8%. There are several platform options available for sending automated texts at desired frequencies, encouraging a response and further dialogue. 

Medication adherence takes a joint effort in open communication between the patient, prescriber, and pharmacist. Allowing patients to feel heard in a non-judgmental environment, providing patient education, and frequently checking in with the patient all contribute to the patient taking more responsibility for their health. This leads to higher adherence rates, ultimately improving therapeutic outcomes.

BioMatrix Specialty Pharmacy is committed to provide an individualized clinical approach to specialty pharmacy and infusion services that improve health outcomes and empower patients to live each day to its fullest potential. Learn more. https://www.biomatrixsprx.com/about-us

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1. KFF website. https://www.kff.org/health-costs/state-indicator/total-retail-rx-drugs/

2. World Health Organization. Adherence to long term therapies: evidence for action. Geneva: WHO; 2003.

3. Marden B, Martineau C. Emphasize Medication Adherence to Patients. Pharmacy Times website. https://www.pharmacytimes.com/publications/health-system-edition/2019/September2019/emphasize-medication-adherence-to-patients

4. Medication Adherence: The Elephant in the Room. U.S. Pharmacist website. https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room

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