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Geng B, Clark K, Evangelista M, Wolford E. Low rates of headache and migraine associated with intravenous immunoglobulin infusion using a 15-minute rate escalation protocol in 123 patients with primary immunodeficiency. Front Immunol 2023; 13:1075527. [PMID: 36818468 PMCID: PMC9932595 DOI: 10.3389/fimmu.2022.1075527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/16/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Headache and migraine adverse events are common concerns in the administration of intravenous immune globulins (IVIG). Trials of IVIG for primary immunodeficiency (PI) are typically small and have reported headache and migraine data inconsistently. Methods We analyzed headache and migraine in pooled data from three pivotal trials of Gammaplex® 5% and 10% in PI (NCT00278954 from January 18, 2006; NCT01289847 from January 27, 2011; NCT01963143 from September 13, 2013). The trials were pooled in a retrospective analysis that included two 12-month open-label non-comparative trials of the 5% IVIG product and one 6-month open-label crossover bioequivalence trial comparing the 5% IVIG and 10% IVIG products. The population included adult and pediatric patients, who received IVIG infusions of 300-800 mg/kg/infusion every 21 or 28 days using a 15-minute rate escalation protocol. Results In total, 1482 infusions were administered to 123 patients, with 94.6% of infusions achieving the maximum infusion rate. At least one product-related headache was reported in 6.1% (90/1482) of infusions. At least one product-related migraine was reported in 0.5% (7/1482) of infusions. Headache rates were higher for adults vs pediatric patients, females vs males, and 21-day vs 28-day dosing schedules, but were similar for the 5% and 10% IVIG products. Most headaches and migraines occurred during or within 72 hours of the infusion. Rates decreased after the first few infusions. Discussion Patients receiving this IVIG product on a 15-minute rate escalation protocol had low rates of headache and migraine for both the 5% and 10% formulations.
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Affiliation(s)
- Bob Geng
- Division of Allergy & Immunology, University of California, San Diego, CA, United States
| | - Kim Clark
- Global Medical Department, Bio Products Laboratory, Ltd., Elstree, United Kingdom
| | - Mark Evangelista
- Biostatistics Department, Atlantic Research Group, Charlottesville, VA, United States
| | - Eric Wolford
- Global Medical Department, Bio Products Laboratory, Ltd., Elstree, United Kingdom
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Prosser B, Walton TP, Miller C. Reduction of Infusion Time Using a 10% Intravenous Immunoglobulin Formulation With a 15-Minute Rate Escalation Protocol During Staffing Shortages Due to COVID-19. JOURNAL OF INFUSION NURSING 2022; 45:299-305. [PMID: 36322947 PMCID: PMC9631764 DOI: 10.1097/nan.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The COVID-19 pandemic changed home infusion nursing dramatically by increasing demand for home infusion nurses while decreasing their availability. Home infusion of intravenous immunoglobulin (IVIg) is an option for treatment of numerous conditions and requires considerable infusion time. Use of a higher-concentration IVIg product and shorter escalation increments may decrease required infusion time. The authors conducted a retrospective database analysis that identified 23 patients receiving IVIg before transitioning to a 10% IVIg product with a 15-minute rate escalation protocol (Gammaplex 10% IVIg) and evaluated the total infusion time before and after the transition. Among the 23 who received IVIg, the mean ± SD IVIg dose per dosing cycle before transitioning was 1.2 ± 0.7 g/kg given in 1 to 5 infusions per cycle. The mean ± SD time per infusion was 2.8 ± 0.8 hours before the transition and 2.6 ± 0.7 hours per infusion after the transition. The infusion time decreased after transition in 13 patients (56.5%), did not change in 5 patients (21.7%), and increased in 5 patients (21.7%). Nurse education on IVIg rate escalation may facilitate faster achievement of the maximum safe infusion rate and reduce infusion times. A trial transition to this 10% IVIg product with a 15-minute rate escalation protocol may also reduce infusion times.
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Affiliation(s)
- Barbara Prosser
- Corresponding Author: Barbara Prosser, RPh, Soleo Health, 2801 Network Blvd, Suite 505, Frisco, TX 75034 ()
| | - Timothy P. Walton
- Soleo Health, Frisco, Texas
- Barbara Prosser, RPh, most recently served as the vice president of Health Economics and Outcomes Research at Soleo Health. She spearheaded research and outcome measurement opportunities to provide real-world evidence related to the patient experience and therapy outcomes. Her 35 years of experience in healthcare fields include 10 years with The Joint Commission and leadership roles with Walgreens Specialty Infusion, Accredo Health Group, Critical Care System and Soleo Health. She is an active member of the National Home Infusion Association and has served as a member of their standards/accreditation committee. She earned her Bachelor of Science in Pharmacy from the University of Florida
- Timothy P. Walton, MHS, CCRP, is the vice president of Scientific Research and Data Quality at Soleo Health. He manages and monitors health care quality measures, data metrics, data quality, health economics and value strategies, and real-world evidence for prescribers, payers and manufacturers in multiple disease states and therapy programs. Tim has more than 25 years of experience in clinical research and health economics and outcomes research, and more than 10 years of experience in various leadership roles in the home infusion/specialty sector. He earned his master's degree in Health Care Sciences/Administration from Washington University School of Medicine in St. Louis and is a Society of Clinical Research Associates Certified Clinical Research Professional
- Christine Miller, PharmD, is the manager of Health Economics and Outcomes Research at Soleo Health. She develops and coordinates strategies related to outcomes studies, real-world evidence, and market access for new therapies and services, and offers clinical guidance on these topics throughout Soleo Health. As a clinical pharmacist, she has more than 10 years of specialty infusion experience from working at Soleo Health, Walgreens Infusion Services, and Critical Care Systems and completing a pharmacy residency in the home infusion setting. She earned her PharmD at the University of the Sciences
| | - Christine Miller
- Soleo Health, Frisco, Texas
- Barbara Prosser, RPh, most recently served as the vice president of Health Economics and Outcomes Research at Soleo Health. She spearheaded research and outcome measurement opportunities to provide real-world evidence related to the patient experience and therapy outcomes. Her 35 years of experience in healthcare fields include 10 years with The Joint Commission and leadership roles with Walgreens Specialty Infusion, Accredo Health Group, Critical Care System and Soleo Health. She is an active member of the National Home Infusion Association and has served as a member of their standards/accreditation committee. She earned her Bachelor of Science in Pharmacy from the University of Florida
- Timothy P. Walton, MHS, CCRP, is the vice president of Scientific Research and Data Quality at Soleo Health. He manages and monitors health care quality measures, data metrics, data quality, health economics and value strategies, and real-world evidence for prescribers, payers and manufacturers in multiple disease states and therapy programs. Tim has more than 25 years of experience in clinical research and health economics and outcomes research, and more than 10 years of experience in various leadership roles in the home infusion/specialty sector. He earned his master's degree in Health Care Sciences/Administration from Washington University School of Medicine in St. Louis and is a Society of Clinical Research Associates Certified Clinical Research Professional
- Christine Miller, PharmD, is the manager of Health Economics and Outcomes Research at Soleo Health. She develops and coordinates strategies related to outcomes studies, real-world evidence, and market access for new therapies and services, and offers clinical guidance on these topics throughout Soleo Health. As a clinical pharmacist, she has more than 10 years of specialty infusion experience from working at Soleo Health, Walgreens Infusion Services, and Critical Care Systems and completing a pharmacy residency in the home infusion setting. She earned her PharmD at the University of the Sciences
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Gao L, Lau YK, Wei R, O'Brien L, Long A, Piao Y, Abada P. Evaluating clinical impact of a shortened infusion duration for ramucirumab: a model-based approach. Cancer Chemother Pharmacol 2021; 87:635-645. [PMID: 33532866 PMCID: PMC8026424 DOI: 10.1007/s00280-020-04223-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE We investigated the impact of infusion duration (30 and 60 min) on the pharmacokinetic profile of ramucirumab using a population pharmacokinetic (PopPK) modeling approach. We also assessed the relationship between infusion rate and incidence of immediate infusion-related reactions (IRRs; occurring on the day of administration) using ramucirumab phase II/III study data. METHODS The impact of different infusion durations (30 vs. 60 min) on the time-course of ramucirumab concentration profiles were evaluated using a PopPK model, established using ramucirumab pharmacokinetic data from 2522 patients. Logistic regression was used to evaluate the association between ramucirumab infusion rate and incidence of immediate IRRs in clinical trials. RESULTS Ramucirumab time-course concentration profiles were equivalent following a 30- or 60-min infusion. In the pooled clinical study dataset, 254 of 3216 (7.9%) patients receiving ramucirumab experienced at least one immediate IRR (any grade). When grouped according to infusion rate quartile, the incidence of immediate IRRs (any grade or grade ≥ 3) was similar across quartiles; findings were confirmed in sensitivity analyses. The risk of immediate IRRs was not found to be associated with infusion rate based on multivariate logistic analysis. CONCLUSION Shortening the infusion duration of ramucirumab from 60 to 30 min has no impact on ramucirumab exposure. Analysis of trial data found no relationship between an increased risk of immediate IRRs and a faster infusion rate. Such a change in infusion duration is unlikely to affect the clinical efficacy or overall safety profile of ramucirumab.
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Affiliation(s)
- Ling Gao
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Yiu-Keung Lau
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Ran Wei
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Lisa O'Brien
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Amanda Long
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | - Paolo Abada
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
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