Selecting a polyclonal immune globulin treatment for a patient with primary immune deficiency disease: Role of the clinical pharmacist

Purpose Considerations for selecting an immune globulin treatment, transitioning patients with primary immune deficiency disease who are receiving long-term treatment between settings of care, and the role of the pharmacist in these endeavors are described. Summary Numerous immune globulin formulations are commercially available, and these formulations differ in immune globulin concentration, stabilizing additives, trace non–immune globulin proteins, and the manufacturing process, all of which may elicit different adverse reactions in patients. Patients may also exhibit differences in tolerability to the route of administration. The complex process of formulating, establishing, and maintaining an immune globulin treatment regimen requires the participation of the patient and healthcare providers. For patients transitioning between settings of care, particular attention must be paid to any changes to a treatment that has been individualized for a patient. Factors affecting the decision process include medical history, immune globulin formulation characteristics, formulary stock, payer formulary, and patient preference. For patients switching between immune globulin formulations or routes of administration, dosage adjustments of and tolerance to immune globulin may be important considerations. A clinical pharmacist with knowledge of the pharmaceutical suitability of immune globulin formulations can safely facilitate these transitions. Conclusion Selecting a route of administration for and formulation of immune globulin involves the consideration of many factors, including the patient’s medical history, formulation characteristics, formulary stock, payer formulary, and patient preference. A pharmacist is essential in helping the patient navigate the decision-making process and in coordinating care and communication among patients, caregivers, and healthcare providers to monitor patient progress and adherence and ensure safe and efficient transitions of care.