Transplant

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Enhancing Transplant Patient Care: The Vital Role of Qualified Home Nursing Services in Home Infusion

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An older white woman sits next to a smiling Asian nurse.

Home infusion therapy has transformed healthcare by allowing patients to receive treatment in the comfort of their own homes. For individuals undergoing organ transplant procedures, this plays a pivotal role in their recovery and ongoing care. Here we discuss how the success of home infusion, particularly for transplant patients, hinges significantly on the expertise and support provided by qualified home nursing services.

The Significance of Home Infusion for Transplant Patients

Transplant patients benefit from home infusion both before and after transplant. Before transplant, patients are dealing with chronic complications that have caused them to need a transplant. Getting their immune systems prepared can require timed medication therapies such as desensitization. Post-transplant, patients are at risk of infection because of immune-suppressing anti-rejection drugs and/or because they develop chronic or long-term conditions compromising their immune systems.

Hospitals and infusion centers can take every precaution available, yet in these environments patients still have the potential for exposure to bacteria or viruses they would likely not encounter in their homes. Home infusion provides a safe and effective means to help transplant patients manage their prescribed therapy. Patients can receive their medication in the secure and familiar environment of their own homes, administered by a clinically-trained infusion nurse. Benefits include safety, convenience, cost-savings, and patient well being. 

Challenges and the Need for Qualified Home Nursing Services

The complexity of post-transplant care demands meticulous attention and specialized knowledge. This is where qualified home nursing services come into play. These professionals bring a wealth of expertise providing personalized care, monitoring patients' health, administering medications, and offering vital guidance to patients and their families.

The expertise of qualified home nurses extends beyond administering medications. They serve as educators, ensuring that patients and their caregivers understand the treatment protocols, potential side effects, and the importance of adherence to prescribed regimens. Their vigilance in monitoring for any signs of complications or adverse reactions is crucial in preempting potential issues and ensuring timely interventions.

Extensive Vetting and Training

BioMatrix ensures a robust network of over 200 contracted nursing agencies nationwide, all meticulously vetted to align with Infusion Nurses Society guidelines. Similarly, individual home infusion nurses undergo a thorough assessment and preparation, including evaluations of their competency and detailed reviews of prescribed therapy. Prior to service, these nurses meet with BioMatrix nurse clinicians, ensuring a suitable match for the patient's needs. Should any nurse not meet their stringent competency standards, BioMatrix promptly reassigns the case to maintain their commitment to exceptional care.

Site-of-Care Coordination

We are well aware of how important it is for patients to avoid conflicts with work and other obligations. BioMatrix nurse clinicians aim to create plans that stay within the parameters of all protocols and instructions that their MD has ordered while causing the least possible disruption to patients' routines. When administering in-home with assistance from one of our home care nurses, our nurses work with patients and prescribers to make therapy administration as safe, convenient, and comfortable as possible. 

Safety Protocols and Clinical Interventions

All BioMatrix nurse professionals follow CDC guidelines for hygiene and germ reduction and help patients mitigate any issues to establish a safe environment for home infusion. When entering a patient’s home, the home infusion nurses follow all standard precautions and wear appropriate personal protective equipment. They also take the time to identify and review safety measures the patient can follow in the home both during and after infusion.

Following each home infusion, the home infusion nurse will submit a report to the BioMatrix clinical team to track response to therapy, monitor for adverse events, and help personalize and improve future care. By synthesizing clinical, social, and drug utilization information, our nursing team’s actionable interventions help improve health and save lives. Our interventions support patient adherence to therapy, reduce side effects, and help address both critical and every day issues related to life with a chronic health condition. 

Patient Education

We understand that starting a new therapy and navigating the treatment process can be challenging and confusing for a patient. Where appropriate, our nursing team provides self-administration training for injectable or infusible drugs, allowing patients to more independently manage their condition. Our nurses can also guide patients post administration to maintain therapy adherence, minimize or manage side effects, and answer questions that may arise throughout their treatment regimen.

The BioMatrix clinical team includes compassionate nurses who have extensive training and experience with rare diseases, infusion therapies, and complex medical conditions. 

Our nurses work together with patients, caregivers, pharmacists, and prescribers to coordinate the optimal site of care, conduct nursing interventions, and provide patient education.

Watch our video here to learn more about our home infusion services.

DISCLAIMER: THIS IS NOT MEDICAL OR LEGAL ADVICE. All information, content, and material is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider or as legal advice. Please consult a physician or other health care professional for your specific health care and/or medical needs or concerns and never disregard professional medical advice or delay in seeking it because of something you have read here or on our website.

Financial Resource Guide

Living with a chronic condition can create additional healthcare costs while also impeding one’s ability to work. Our financial resource guide can help. 

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Home Infusion for Transplant Patients

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BioMatrix Specialty Pharmacy provides home infusion services allowing patients to receive therapy from the comfort and safety of home. This article provides a brief overview of how our clinical team works to support home infusion for transplant patients.

Home infusion provides a safe and effective means to help transplant patients manage their prescribed therapy. Hospitals and infusion centers can take every precaution available, yet in these environments patients still have the potential for exposure to bacteria or viruses they would likely not encounter in their homes. Transplant patients benefit from home infusion both before and after transplant. Before the transplant, many patients are at greater risk for infection given their diagnosis and the procedures they have endured. Post-transplant, patients are at risk of infection because of immune-suppressing anti-rejection drugs and/or because they develop comorbidities compromising their immune systems. 

BioMatrix’s focus on safety begins well before the patient is infused with their first dose of medication in the home. 

Even before the pandemic, our transplant professionals followed rigorous safety protocols to ensure the health and safety of the patients we serve. Our clinical team includes nurses and pharmacists who are experts in transplant therapy. Many have years of transplant experience, and team members stay up to date on all current literature surrounding the use of specialty medications provided for transplant-related diagnoses. Our team follows transplant-specific protocols to promote the health and safety of our patients and home infusion nurses. Each clinician has the responsibility of not only knowing each transplant-specific or medication-specific protocol, but also ensuring that the protocol is strictly followed for optimal results.  

Our nursing and pharmacy teams work hand in hand at every step of the patient journey. This includes our efforts around home infusion services. To support our patients across the country, BioMatrix has contracted with over 200 Nursing agencies nationwide. We continually bring new agencies into the fold. Each agency is thoroughly vetted to ensure that they meet our rigorous standards and are knowledgeable regarding the Infusion Nurses Society guidelines for infusion therapy in the home.   

Just as the nursing agencies we contract with are thoroughly vetted, so too are the individual home infusion nurses. Every home infusion nurse assigned to enter a patient’s home is required to meet (over the phone or virtually) with our nurse clinicians prior to providing service. Our nurses evaluate the infusion RN’s level of competency to provide the care ordered. If further education or training is needed this is arranged and completed before the start of care. Prescribed therapy is reviewed in detail to make sure the appropriate protocols are followed and the services provided are safe and seamless. If at any time our nurse clinicians determine that a particular home infusion nurse does not meet the standard of competency that we at BioMatrix strive for, we re-group and re-staff the case with an alternate home infusion nurse.  

When entering a patient’s home, the home infusion nurses we work with follow all standard precautions and wear appropriate personal protective equipment. They also take the time to identify and review safety measures the patient can follow in the home both during and after infusion. Working together our team helps patients mitigate any issues to establish a safe environment for home infusion.  

BioMatrix is committed to providing the highest level of specialty pharmacy service and support.

Our team has years of transplant experience and follows highly coordinated, transplant-specific protocols promoting the health, safety, and well-being of every patient served.

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Diabetes, Chronic Kidney Disease (CKD), and Kidney Transplants

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According to the CDC, about 1 in 10 Americans have diabetes.1 In addition, roughly 1 in 3 adults with diabetes have chronic kidney disease (CKD). Both diabetes type 1 and 2 can cause CKD.2 In this article, we’ll discuss the relationship between diabetes and CKD and when kidney transplants are needed.

What is diabetes?

Diabetes is diagnosed when the body doesn’t produce insulin or doesn’t use insulin well. Since your body uses insulin to convert sugar into energy, lack of or inefficient use causes high blood sugar. Over time, this can cause serious health issues. Type 1 diabetes is when your body doesn’t produce any insulin at all; you will need to take insulin everyday to survive. Type 2 diabetes is when your body doesn’t use insulin well; this type of diabetes can sometimes be prevented or managed with healthy lifestyle choices.

How does diabetes progress into CKD?

Chronic kidney disease is when your kidneys lose function over time. While diabetes is a leading contributor to CKD, high blood pressure can also lead to CKD. Diabetes causes CKD when high blood sugar levels damage blood vessels and nephrons (filters) in the kidneys. Fortunately, CKD takes a long time to develop. Unfortunately, there are usually no signs or symptoms. If you have diabetes, it’s important that your doctor checks you for CKD. This typically consists of blood and urine tests which detect whether your kidneys are working properly.

Can CKD be treated?

There is no cure for CKD, but treatment along with living a healthy lifestyle can sometimes keep it from getting worse. It’s important to note, however, that the existing damage cannot be undone.3 Even if the underlying condition like diabetes or high blood pressure has been controlled, CKD can progress to end-stage kidney disease when the kidneys can’t keep up waste and fluid clearance on their own. When this happens, patients need to either go on dialysis or have a kidney transplant.4 Many patients go on dialysis until they are able to receive a kidney. Sometimes because of organ rejection, the reverse happens.

Tracy, who had kidney disease due to type 1 diabetes, had a kidney transplant. However, because of organ rejection, she had to go on dialysis. “​​Even though it made me feel better, dialysis also wore me out and took a toll on my body. Everything dialysis entails—food, liquids, fistula, medications, schedules—was all I thought about.”

Fortunately, Tracy received IG treatment which lowered her antibodies, allowing for her second kidney transplant to be successful. “I feel so fortunate to have been given a second chance to have a “normal” life and be free of the burden of dialysis!”

Summary

With chronic kidney disease often having no symptoms, if you have diabetes 1 or 2, ask your doctor about being tested for CKD. While living a healthy lifestyle is always important and can help kidney damage from getting worse, the existing damage cannot be undone. When kidneys lose their function (end-stage kidney disease), dialysis and/or a kidney transplant is needed. Though there can be complications with kidney transplants, treatments like IG are allowing patients like Tracy to find hope and a new “normal”.

BioMatrix supports patient populations across the transplant continuum.

Prior to transplant, our Solid Organ desensitization program prepares even the most sensitized patients. Post-transplant, BioMatrix immunosuppressive medication program facilitates optimal outcomes. We integrate desensitization and immunosuppressive therapy with advanced digital health technology for full-spectrum transplant care. Learn more about how we are providing hope and a better quality of life for transplant patients.

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Tragedy to Triumph: The Story of Tom’s Heart

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Tragedy to Triumph—The Story of Tom's Heart is a new book outlining the emotional journey of the donor family and the heart recipient to encourage organ and tissue donation. BioMatrix is a transplant-focused specialty pharmacy dedicated to the unique needs of the transplant community. We supported this book to help authors Janet and Pete share their exceptional story and raise awareness about the importance of organ donation. We recently caught up with the book’s authors to bring you this interview.

What inspired you to team up and co-author Tragedy to Triumph, the Story of Tom’s Heart?

Pete: The journey started 24 years ago when I received my heart transplant—Tom’s heart. Even though Tom’s mom, Janet, and I exchanged some letters, we did not actually speak until about 2 years after the transplant. When you receive such a lifesaving gift, there is an inherit guilt that someone had to die so you could live. When a transplant recipient writes to their donor family, how do you say thank you for a gift resulting from tragedy? The words come off as hollow. I felt the book would provide a great opportunity to leave a written legacy honoring my donor and his family while encouraging others to consider organ donation.

Jan: I was ecstatic to receive a thank you letter from Pete in July of 1998, one year after my son’s death. We continued these letters which helped us get to know each other and feel more comfortable. Without expressed consent, all donor and recipient contact information remains confidential, and correspondence occurs through the organ procurement agency (OPO). I requested the OPO provide my personal information to Pete so he could contact me directly. Pete called me immediately after receiving my contact information, on December 22nd. He thanked me for the gift of life. It was incredible and hard to believe that I was speaking to the man that received Tom’s heart. I felt an immediate bond. Christmas was a few days later, a very difficult time because I missed Tom. Pete called me again on Christmas, and I had the opportunity to speak with his entire family. They could not thank me enough. It was the best gift I received that year. During my conversation with Pete, he asked if I would be willing to do two things. Pete first wanted to know if I would be willing to write a book together with him. Second, he asked if I would be willing to speak with him publicly to promote the importance of organ donation. I immediately said yes.

What was it like meeting each other for the first time?

Pete: You have no idea how many emotions can coexist at one time during such a moment. It’s difficult to describe. After our initial embrace, I asked if she wanted to listen to my heartbeat. Time seemed to stand still. That moment was a culmination of so many experiences and absolute raw emotion. I will never forget it.

Jan: It was absolutely surreal. Even though I knew a heart transplant was medically possible, how do you believe your son’s heart is in someone else? To know I carried, birthed, and cared for Tom and that his heart now allowed Pete’s life to be restored was both a miracle and a joy. Putting my head on Pete’s chest and listening to my son’s heart, now Pete’s, brought a connection to Tom that I thought I’d lost forever. The sound of that beating heart brought comfort and joy to my soul, a tear to my eye, and immediately strengthened my bond with Pete. My thoughts and feelings are reflected in a poem I wrote on pages 182-184 of the book.

What’s the key message you hope to convey with the book?

Pete: Without a doubt, the goal is to establish organ donation as the norm. For too long choosing to be an organ donor has been the exception and not the rule. This is a guidebook that I hope acts as a catalyst to encourage more organ donation. This is the first book including the perspective from both the recipient and donor family. In addition to encouraging donation, I hope this book provides comfort and support for other donor families and transplant recipients in the community.

Jan: Saying yes to donation is definitely the key message. I hope the book encourages people to consider giving the gift of life to others. I also hope the book helps donor families see a purpose in their tragedy and aid in their future healing. If this book encourages, inspires, or helps others in any way I would be most honored. My wish is that transplant recipients value and care for their lifesaving gift because it was given at a high cost. Pete has indeed cared for his heart!

Learn More

In tragedy there is also hope. Help make organ donation the norm as opposed to the exception. Please click the button below for more information and to order your copy of the book.

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Medication Reconciliation: Why It's Important and Steps for Completion

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Medication reconciliation is when you go over all of the medication you are taking (both prescription and over-the-counter) with a healthcare provider, such as your doctor or pharmacist.

Over-the-counter and prescription medications are used frequently to treat thousands of unique health issues. Many times, however, patients are not openly communicating with their primary care provider about all the pills they are taking. Patients may assume that their doctor is aware of medications prescribed by specialists or other providers, but that’s not always the case. There are two easy steps to getting your medication reconciliation complete: 1) Bring your bottles, and make a list. 2) Talk with your doctor or pharmacist about all your medications.

1) Bring your bottles, and make a list!

Reconciling your medications by bringing the physical bottles is vital for several reasons:

  • It helps avoid medical errors that could result from an incomplete understanding of past and present medical treatment.

  • There is less chance that a medication or prescription is forgotten or overlooked.

  • Your provider can more effectively work with you to consolidate and avoid unnecessary duplications of medications or prescriptions that treat the same symptoms.

  • Your provider can look for dosing errors and discuss proper administration of your medications.

  • With a complete inventory of your medications, your provider can help you identify and avoid adverse drug interactions.

When you bring in your bottles, be sure they are all tightly closed and carried in a safe bag so none are lost or misplaced.

An alternative option is to create a list of the over-the-counter and prescription medications you regularly take. You will have to update this list as doses and drugs change. Bring the list to every appointment as a reference when speaking with your primary care provider.

2) Talk with your doctor or pharmacist about all the medications you are taking. Do this once a year or whenever a new medication is added to what you are currently taking.

It’s important to let your doctor (or their medical assistant) know ahead of time that you want to complete a medication reconciliation. They’ll need to book an appointment with enough time and also prepare beforehand. If you wish to work with your pharmacist to complete a medication reconciliation, call your pharmacy to ask for a good time to come in and discuss all your concerns. Just like with your doctor, this allows your pharmacist the time to prepare for your appointment and will help ensure that they have enough time to complete your medication reconciliation.

Your Pharmacist Is a Medication Ally

A pharmacist’s work goes far beyond measuring pills into bottles, as he/she can be a helpful resource for patients who have questions or concerns about medications they are prescribed or purchasing.

With a quick phone call or a question asked at pickup, a pharmacist can clarify how much medication you should take based on your prescription; how to administer medication to yourself, a child or an elderly parent; and recommended solutions for your concerns.

Reconciliation Is a Joint Responsibility

The responsibility of managing medications is equally shared between a patient and his/her health care provider. While the provider is responsible for writing prescriptions and educating patients, it’s ultimately up to the patient to follow the provider’s recommendations.

Consistent reconciliation of your medications will help ensure that you and your primary care provider are on the same page and that your health needs are being addressed in the best possible way.

References

Barnsteiner JH. Medication Reconciliation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 38. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2648/

Salanitro AH, Kripalani S, Resnic J, et al. Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS). BMC Health Serv Res. 2013;13:230. Published 2013 Jun 25. doi:10.1186/1472-6963-13-230

Redmond P, Grimes TC, McDonnell R, Boland F, Hughes C, Fahey T. Impact of medication reconciliation for improving transitions of care. Cochrane Database Syst Rev. 2018;8(8):CD010791. Published 2018 Aug 23. doi:10.1002/14651858.CD010791.pub2

Anderson LJ, Schnipper JL, Nuckols TK, et al. Effect of medication reconciliation interventions on outcomes: A systematic overview of systematic reviews. Am J Health Syst Pharm. 2019;76(24):2028-2040. doi:10.1093/ajhp/zxz236

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Tips for Managing High Cholesterol

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Who needs to be on cholesterol lowering medication?

Your treatment plan for high cholesterol will depend on your current cholesterol levels and your risk of heart disease and stroke. Your risk for heart disease and stroke depends on other risk factors, including high blood pressure and high blood pressure treatment, smoking status, age, high-density lipoprotein cholesterol level, total cholesterol level, diabetes, family history, and whether you have already had a heart attack or stroke.

Your health care provider may prescribe medicine if:

  • You have already had a heart attack or stroke, or you have peripheral arterial disease 

  • Your LDL cholesterol level is 190 mg/dL or higher

  • You are 40–75 years old with diabetes and an LDL cholesterol level of 70 mg/dL or higher

  • You are 40–75 years old with a high risk of developing heart disease or stroke and an LDL cholesterol level of 70 mg/dL or higher

Talk with your health care team about how you can lower your risk for heart disease.

What are the types of cholesterol-lowering medications?  

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How do I manage my high cholesterol?

Take Medications as Directed

If you take medicine to treat high low-density lipoprotein (LDL) cholesterol, heart disease, stroke, or diabetes, follow your health care team’s instructions carefully. Always ask questions if you don’t understand something. Never stop taking your medicine without first talking to your doctor, nurse, or pharmacist.

Make Healthy Lifestyle Changes

You can take steps to lower your high LDL cholesterol levels by making healthy changes to your lifestyle:

  • Limit foods high in saturated fat. Saturated fats come from animal products (such as cheese, fatty meats, and dairy desserts) and tropical oils (such as palm oil). Foods that are higher in saturated fat may be high in cholesterol

  • Choose foods that are low in saturated fat, trans fat, sodium (salt), and added sugars. These foods include lean meats; seafood; fat-free or low-fat milk, cheese, and yogurt; whole grains; and fruits and vegetables. 

  • Eat foods naturally high in fiber, such as oatmeal and beans (black, pinto, kidney, lima, and others) and unsaturated fats, which can be found in avocado, vegetable oils like olive oil, and nuts). These foods may help prevent and manage high levels of low-density lipoprotein (LDL, or “bad”) cholesterol and triglycerides while increasing high-density lipoprotein (HDL, or “good”) cholesterol levels.

  • Get active as a family. For adults, the Surgeon General recommends 2 hours and 30 minutes of moderate-intensity exercise, such as brisk walking or bicycling, every week. Children and adolescents should get 1 hour of physical activity every day. 

  • Make physical activity a part of each day. Take the stairs instead of the elevator, park a little farther away, walk to the store, or do jumping jacks during commercials.

  • Smoking damages your blood vessels, speeds up the hardening of the arteries, and greatly increases your risk for heart disease. If you don’t smoke, don’t start. If you do smoke, quitting will lower your risk for heart disease.

  • Avoid drinking too much alcohol. Men should have no more than two drinks per day, and women should have no more than one.

Talk with Your Healthcare Team

You and your health care team can work together to prevent or treat diabetes and ensure that it doesn’t lead to high LDL cholesterol. Discuss your treatment plan regularly, and bring a list of questions to your appointments.

Check Your Cholesterol Regularly

You may need to have your cholesterol levels checked at least once every 4 to 6 years if you do not have heart disease. Some people need to get their cholesterol checked more often or less often. Talk with your health care team about the timeline that is best for you.

References

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25). doi:10.1161/cir.0000000000000624 

Mytilinaiou M, Kyrou I, Khan M, Grammatopoulos DK, Randeva HS. Familial Hypercholesterolemia: New Horizons for Diagnosis and Effective Management. Front Pharmacol. 2018;9:707. Published 2018 Jul 12. doi:10.3389/fphar.2018.00707

Mannu GS, Zaman MJ, Gupta A, Rehman HU, Myint PK. Evidence of lifestyle modification in the management of hypercholesterolemia. Curr Cardiol Rev. 2013;9(1):2-14. doi:10.2174/157340313805076313

Agabiti Rosei E, Salvetti M. Management of Hypercholesterolemia, Appropriateness of Therapeutic Approaches and New Drugs in Patients with High Cardiovascular Risk. High Blood Press Cardiovasc Prev. 2016;23(3):217-230. doi:10.1007/s40292-016-0155-2

Our entire team is committed to maintaining the health and wellbeing of those we are privileged to serve.

For updated information regarding our response to developments related to COVID-19, a letter from our CEO, and early refill requests, please click here.

Stay healthy, and be well.

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An Overview of Intravenous and Subcutaneous Immunoglobulin (IVIG/SCIG) In Immunology

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IVIG and SCIG are pinnacle therapies for the treatment of primary humoral immunodeficiencies and are gaining utility across the scope of immunology.

Immunoglobulin may be used to increase serum IgG, modulate the immune system, and help prevent recurrent infections.1 Depending on the specific indication, immunoglobulin therapy may be FDA approved or used off-label with recommendations from clinical guidelines.

Indications with FDA approval for IVIG2

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Indications with off-label use for IVIG

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Monitoring

Monitoring for IVIG patients typically includes:

  • Blood pressure before, during and after the infusion2
    • - IVIG may cause hypotension or hypertension
  • Renal function3
    • - Monitor before initiating therapy, and then at appropriate intervals.
    - IVIG has a US boxed warning for renal dysfunction.
  • IgG concentrations2,11,12
    • - Monitor before initiating therapy, and then every 4-6 months. Measure every 2-3 months if switching from IV to SC IG.
    - IgG reference level: 700-1600 mg/dL
    - Goal trough level: >600 mg/dL OR at least as high as the previous trough level from the previous IVIG dose.
  • IgA concentrations2,11
    • - Low levels of IgA may lead to the formation of IgA antibodies.
    - Patients with IgA antibodies are at a greater risk of infusion reactions from IVIG.
    - Use low IgA IVIG for patients with low IgA and monitor closely for infusion reactions.
    - IgA reference level: 70-400 mg/dL
  • Signs of thrombosis2
    • - IVIG has box warning for increased risk of thrombosis.
    - Patients who have difficulties ambulating may be at a greater risk of thrombosis events.
  • Clinical response

The role of subcutaneous immunoglobulin (SCIG)

SCIG offers several benefits for patients who receive immunoglobulin therapy. The primary benefit is convenience, as the patient may be trained to self-administer SCIG or be able to have a caregiver trained to administer at home. Patients who have a busy schedule, live far away from infusion centers or who have transportation barriers may find great freedom in switching from IVIG to SCIG. SCIG produces a less dramatic spike in serum IgG levels which is beneficial in reducing systemic side effects. Additionally, more frequent dosing of SCIG has been shown to produce higher trough levels and patients may experience less variations in clinical response.13

The main limitations of SCIG are increased infusion-site reactions, increased dosing frequency and less opportunity for healthcare monitoring during infusions. For these reasons, SCIG should be reserved for patients whose disease states are well controlled. If patients experience a decrease in therapeutic response while on SCIG, they may need to be switched back to IVIG therapy.

SCIG therapy is currently FDA approved for primary immunodeficiencies.2 Refer to each product’s prescribing information leaflet for dosing guidance.

Final considerations

The use of IVIG and SCIG in immunology is an evolving topic with new research conducted on a regular basis. Consult your institution’s clinical databases to stay up to date with the latest information regarding IVIG in specific indications.

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. Perez EE, Orange JS, Bonilla F, et al. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol. 2017;139(3S):S1-S46. doi:10.1016/j.jaci.2016.09.023 

  2. 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.

  3. Boughton BJ, Jackson N, Lim S, Smith N. Randomized trial of intravenous immunoglobulin prophylaxis for patients with chronic lymphocytic leukaemia and secondary hypogammaglobulinaemia. Clin Lab Haematol. 1995;17(1):75-80.

  4. Chapel HM, Lee M, Hargreaves R, Pamphilon DH, Prentice AG. Randomised trial of intravenous immunoglobulin as prophylaxis against infection in plateau-phase multiple myeloma. The UK Group for Immunoglobulin Replacement Therapy in Multiple Myeloma. Lancet. 1994;343(8905):1059-1063.

  5. Intravenous immunoglobulin for the prevention of infection in chronic lymphocytic leukemia. A randomized, controlled clinical trial. Cooperative Group for the Study of Immunoglobulin in Chronic Lymphocytic Leukemia (CGSIGCLL). N Engl J Med. 1988;319(14):902-907.

  6. Griffiths H, Brennan V, Lea J, Bunch C, Lee M, Chapel H. Crossover study of immunoglobulin replacement therapy in patients with low-grade B-cell tumors. Blood. 1989;73(2):366-368.

  7. Anderson D, Ali K, Blanchette V, et al. Guidelines on the use of intravenous immune globulin for hematologic conditions. Transfus Med Rev. 2007;21(2)(suppl 1):s9-s56

  8. Feasby T, Banwell B, Benstead T, et al. Guidelines on the Use of Intravenous Immune Globulin for Neurologic Conditions. Transfus Med Rev. 2007;21(2)(suppl 1):57-107.

  9. Jahnke L1, Applebaum S, Sherman LA, et al. An evaluation of intravenous immunoglobulin in the treatment of human immunodeficiency virus-associated thrombocytopenia. Transfusion. 1994;34(9):759-764

Our entire team is committed to maintaining the health and wellbeing of those we are privileged to serve.

For updated information regarding our response to developments related to COVID-19, a letter from our CEO, and early refill requests, please click here.

Stay healthy, and be well.

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Stay informed on the latest trends in healthcare and specialty pharmacy.

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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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Patient Perspective: Tracy

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Learning, connecting, and sharing stories is an essential component of building community.

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For people living with a rare or chronic health condition, just knowing there are others out there who have walked in similar shoes can be a source of comfort and motivation.

In our first edition, we catch up with Tracy, who shares her story before and after kidney transplant.

Tracy, tell us why you needed to have a transplant?

Due to kidney disease caused by Type 1 diabetes, I found out I needed to have a transplant. When first hearing this from my doctor, to put it mildly, I was shocked. I had no idea what was happening to my body.

What was your life like before you had your transplant?

My sugar levels were not good - I was tired all the time. In January 2009, I underwent surgery and received a kidney and pancreas transplant. Unfortunately, my body quickly rejected the organs and caused me to become very ill. The organs were removed just 5 days later and required 16 blood transfusions. The surgeon reconnected my original organs, which remain in your body following a transplant. After that, I had to receive weekly iron infusions. Trudging along, my original organs held up until May 2010 when I needed to start dialysis.

For the next 3½ years, I received dialysis 3 times per week. My life became all about these 4-hour sessions. Prior to beginning dialysis, a fistula was inserted into my arm. A fistula is a surgically created vascular passageway to make dialysis easier. Pills were taken with each meal and snack, sodium was avoided at all costs, and fluid intake had to be carefully monitored and limited - for example, soup was drained and eaten with a fork and high-sodium restaurants were avoided. Due to the dialysis schedule, vacations were out of the question.

Even though it made me feel better, dialysis also wore me out and took a toll on my body. Everything dialysis entails – food, liquids, fistula, medications, schedules – was all I thought about. When I look back, I realize I was just living day by- day, with no real thought to the future.

Download our free Transplant Patient Medication Guide with helpful information about common medications used after transplant.

What role did IVIg have in your transplant?

My doctor explained, due to my existing organs and the previous blood transfusions, I now had 100% antibodies. Simply put, another transplant would be very difficult as my body would likely again reject the organ. My doctor proceeded to tell me about a study using IVIg. IVIg is supposed to lower antibodies, so another transplant could be possible; he wanted me to try it. Eager to do all I could to prepare for a successful transplant, I received IVIg for 7 months. A nurse came to my home every 2 weeks to administer the 4-hour infusion.

In January 2014, a kidney became available. IVIg helped ensure the transplant was a success! Without IVIg, I would still be on dialysis. Between the family that lovingly donated the kidney and the benefits of IVIg, I feel so fortunate to have been given a second chance to have a “normal” life and be free of the burden of dialysis!

What challenges have you faced post-transplant?

The biggest post-transplant challenge has been changing the way I eat and drink and getting used to the anti-rejection medications. After years of scrutinizing fluid intake, it was difficult to suddenly start drinking tons of water, which is needed to keep the new kidney functioning properly. I still think of fluid in ounces, but it has become easier with time.

The transplant medication routine was very confusing at first. It didn’t help that I felt a little out of it. Someone at the clinic suggested I was experiencing ‘transplant head.’ My husband had to oversee my meds for a little while, but I finally caught on. With time, the fuzzy feeling began to clear up and eventually went away.

Another challenge is that each medication comes with different side effects, which you learn to deal with. Some of the issues I’ve experienced include osteoporosis due to steroids, leading to some issues with my knee and foot. The medicines have caused some puffiness, weight gain, and stomach trouble, so I do watch my diet carefully. I’ve also experienced mild depression, which I understand is somewhat expected. Overall though, it hasn’t been too bad.

Our IVIg and SCIg medication guides make it easy to compare products and reach decisions to fit the needs of your patients. Download these free charts now.

What role has your specialty pharmacy played in helping manage your care?

For the 7 months of receiving IVIg infusions, BioMatrix Specialty Pharmacy shipped all the medication and supplies straight to my home. [When] the homecare nurse arrived, she would have everything needed already at my house. If we had any question at all, we just called BioMatrix. They were very familiar with my history and medical needs. It was comforting to know people so personable and knowledgeable were just a call away. 

What advice would you offer to others with the same diagnosis?

Reducing antibodies with IVIg gave me an opportunity I never thought I’d see again. I’m so happy IVIg is available, allowing me to have a successful outcome. For patients who struggle with high antibodies and who are facing a transplant, I totally recommend speaking to your doctor about it. When you get that crucial call that an organ is available, it feels great to know you have done everything possible to prepare for a successful transplant! I’ve had my kidney now for 5 years! Thank you to my kidney donor, my doctors, IVIg and BioMatrix! I am so very thankful for this second chance at life!

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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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Sign up for our monthly e-newsletter, BioMatrix Abstract.

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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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MATCHGRID™ WITH LAB TOOLS NOW AVAILABLE TO ENHANCE KIDNEY PAIRED DONATION PROGRAMS

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Weston, FL – May 30th, 2018 – BiologicTx ®, a BioMatrix specialty pharmacy, announced today the release of MatchGrid with Lab Tools, a brand new product integrating transplant tissue typing data with advanced analytical tools to promote more successful Kidney Paired Donation (KPD) programs. The software makes it easier to analyze lab data and allows users to track a single antibody, or groups of antibodies over time.

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