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Holloway K, Grundy Q. Toward a Sociology of Plasma Products. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241269136. [PMID: 39140304 DOI: 10.1177/27551938241269136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Over the past 20 years, plasma has become a medical treatment characterized as "liquid gold" to signal its lifesaving potential. Through a manufacturing process termed fractionation, plasma, collected through blood donation, is turned into Plasma Derived Medical Products (PDMPs). The World Health Organization (WHO) has underlined the importance of PDMPs for global health care, including a number of PDMPs on the WHO Model List of Essential Medicines. The process of collecting plasma from a donor, manufacturing plasma derived treatments, and distributing those treatments globally requires the coordination of multiple social actors operating in different social, political and economic contexts, but has received little attention in scholarly literature on public policy or the social sciences. This paper will introduce a set of analytic questions and concepts that can direct a sociology of plasma products. We build on the behavioral turn in the policy sciences to identify relevant policy questions emerging from this field and offer the analytic tools necessary to investigate how different social actors in this space make meaning of plasma. To do this, we will draw on key concepts in the sociology of health and illness.
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Affiliation(s)
- Kelly Holloway
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Quinn Grundy
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Matsushima N, Shibata S, Leu JH, Vermeulen A, Duffner J, Ling LE, Schwartz LB, Harigae H. Pharmacokinetics and Pharmacodynamics of Nipocalimab, a Neonatal Fc Receptor Blocker, in Healthy Japanese Volunteers. Clin Drug Investig 2024; 44:587-599. [PMID: 39073504 PMCID: PMC11339140 DOI: 10.1007/s40261-024-01380-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Nipocalimab is a high-affinity, fully human, effectorless immunoglobulin G1 monoclonal antibody targeting the neonatal Fc receptor and is currently under evaluation for the treatment of rare and prevalent immunoglobulin G autoantibody-mediated and alloantibody-mediated diseases. This phase I, randomized, double-blind, placebo-controlled, single-dose escalation study in healthy Japanese volunteers (N = 24) assessed the safety, pharmacokinetics, and effect on the serum immunoglobulin G level of single doses of nipocalimab. METHODS Volunteers were grouped into three cohorts and received intravenous nipocalimab at 10, 30, or 60 mg/kg or placebo. To complement the study, genetic variation in the Fcγ receptor and transporter subunit of the neonatal Fc receptor was analyzed in Japanese and diverse populations. RESULTS Nipocalimab was generally safe and well tolerated at all dose levels, with three (12.5% [3/24]) volunteers experiencing treatment-emergent adverse events across all nipocalimab doses. Mean serum immunoglobulin G levels decreased in a dose-dependent manner from baseline with nipocalimab treatment compared with placebo. Maximum serum nipocalimab concentrations demonstrated proportional increases with dose, while the area under the concentration-time curve was dose dependent and demonstrated non-linear increases with dose. Mean observed half-life was longer as the dose increased. Analysis of genetic variation in Fcγ receptor and transporter identified no unique Japanese variants or variants that alter amino acid sequences in or near the neonatal Fc receptor immunoglobulin G binding site targeted by nipocalimab. CONCLUSIONS The comparable pharmacokinetic/pharmacodynamic profiles and highly conserved neonatal Fc receptor structure among diverse populations further support the clinical development of nipocalimab for the treatment of various immunoglobulin G autoantibody-mediated and alloantibody-mediated diseases across global sites and populations, including the Japanese population.
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MESH Headings
- Humans
- Receptors, Fc
- Double-Blind Method
- Adult
- Male
- Healthy Volunteers
- Female
- Immunoglobulin G
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacology
- Asian People
- Young Adult
- Japan
- Dose-Response Relationship, Drug
- Middle Aged
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/pharmacology
- Histocompatibility Antigens Class I/genetics
- East Asian People
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Affiliation(s)
- Nobuko Matsushima
- Janssen Pharmaceutical KK, 5-2 Nishi-kanda 3-chome, Chiyoda-ku, Tokyo, 101-0065, Japan.
| | - Sayori Shibata
- Janssen Pharmaceutical KK, 5-2 Nishi-kanda 3-chome, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Jocelyn H Leu
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - An Vermeulen
- Janssen Research & Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jay Duffner
- Janssen Research & Development, LLC, Cambridge, MA, USA
| | - Leona E Ling
- Janssen Research & Development, LLC, Cambridge, MA, USA
| | - Lisa B Schwartz
- Janssen Pharmaceutical Companies of Johnson & Johnson, Raritan, NJ, USA
| | - Hideo Harigae
- Department of Hematology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Pérez-Aliaga AI, Ayerra I, Sánchez-Guillén J, López FJ, Puente F, Aranda A, Domingo JM, Garcés C. Routine results of an algorithm for managing the production of blood components. Vox Sang 2024; 119:541-547. [PMID: 38410835 DOI: 10.1111/vox.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND OBJECTIVES The variability in the number of donations together with a growing demand for platelet concentrates and plasma-derived medicines make us seek solutions aimed at optimizing the processing of blood. Some mathematical models to improve efficiencies in blood banking have been published. The goal of this work is to validate and evaluate an algorithm's impact in the production of blood components in the Blood and Tissues Bank of Aragon (BTBA). MATERIALS AND METHODS A mathematical algorithm was designed, implemented and validated through simulations with real data. It was incorporated into the fractionation area, which uses the Reveos® fractionation system (Terumo BCT) to split blood into its components. After 9 months of daily routine validation, retrospective activity data from the Blood Bank and Transfusion Services before and during the use of the algorithm were compared. RESULTS Using the algorithm, the outdating rate of platelet concentrates (PC) decreased by 87.8% in the blood bank. The average shelf life remaining of PC supplied to Transfusion Services increased by almost 1 day. As a consequence, the outdating rate in the Aragon Transfusion Network decreased by 33%. In addition, extra 100 litres of plasma were obtained in 9 months. CONCLUSIONS The algorithm improves the blood establishment's workflow and facilitates the decision-making process in whole blood processing. It resulted in a decrease in PC outdating rate, increase in PC shelf life and finally an increase in the volume of recovered plasma, leading to significant cost savings.
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Affiliation(s)
| | | | | | - F Javier López
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Aragón, Spain
| | - Fernando Puente
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
| | - Alfonso Aranda
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
| | | | - Carmen Garcés
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
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Koch E, Leiße A, Veseli B, Jensen J, Spekman M, Merz EM, Shehu E, Thibert JB, Beurel-Trehan A, Leblond M, Oesterer M, Kluge P, Forioso D, Clement M. Incentives for plasma donation. Vox Sang 2024. [PMID: 38714322 DOI: 10.1111/vox.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/15/2024] [Accepted: 04/09/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND OBJECTIVES This work provides an overview of the incentives used for plasma donation in Europe and beyond. The overview can provide new ideas to blood establishments. MATERIALS AND METHODS We conducted a systematic online search of incentives used and asked national experts to validate the data across all European Union countries as well as other European and non-European countries. We categorized the data into level of incentive (using the Nuffield Council on Bioethics' rungs [2011]) and country. RESULTS We analysed more than 490 organizations across 26 countries. Our findings reveal different incentives used in these countries. Snacks and pre-donation health checks are commonly provided. In addition, loyalty programmes, small gifts, vouchers, lotteries, travel compensations and time off from work extend the strategic incentive portfolio. Only seven countries offer financial compensation ranging from the equivalent of 10-35€ for European countries. In countries with a decentralized model, where more than one organization collects plasma, we observe that more diversified incentive strategies are generally used, including monetary and non-monetary incentives. In countries with a centralized model, where only one organization is allowed to collect plasma, financial compensation is usually not offered. Centralized plasma collection without financial compensation relies on a wider range of non-monetary incentives than with financial compensation. CONCLUSION The country group analysis offers valuable insights into the relationship between incentive strategies and the prevailing centralized versus decentralized plasma collection model. This overview provides a broader understanding of incentives used by blood establishments and offers avenues for future practice.
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Affiliation(s)
- Elena Koch
- Research Group on Health Marketing, Institute for Marketing, University of Hamburg, Hamburg, Germany
| | - Antonia Leiße
- Research Group on Health Marketing, Institute for Marketing, University of Hamburg, Hamburg, Germany
| | - Besarta Veseli
- Research Group on Health Marketing, Institute for Marketing, University of Hamburg, Hamburg, Germany
| | - Johannes Jensen
- Research Group on Health Marketing, Institute for Marketing, University of Hamburg, Hamburg, Germany
| | - Marloes Spekman
- Department of Donor Medicine Research, Research Group on Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Eva-Maria Merz
- Department of Donor Medicine Research, Research Group on Donor Studies, Sanquin Research, Amsterdam, The Netherlands
- Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Edlira Shehu
- University of Groningen, Groningen, The Netherlands
| | - Jean-Baptiste Thibert
- Etablissement Français du Sang, Rennes, France
- Institute of Law and Political Science, University of Rennes, Rennes, France
| | - Antoine Beurel-Trehan
- Etablissement Français du Sang, Rennes, France
- Laboratory of Psychology: Cognition, Behavior, Communication, University of Rennes 2, Rennes, France
| | | | - Martin Oesterer
- DRK-Blood Service Baden-Wuerttemberg-Hessen, Mannheim, Germany
| | - Philipp Kluge
- DRK-Blood Service Baden-Wuerttemberg-Hessen, Mannheim, Germany
| | - Donata Forioso
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | - Michel Clement
- Research Group on Health Marketing, Institute for Marketing, University of Hamburg, Hamburg, Germany
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Bansal N, Khajuria K, Kaur Cheema R, Sharma A, Singh Bajwa B. Implementation of Indian National plasma policy at blood bank of a tertiary care hospital: A step towards strengthening of blood transfusion services. Transfus Clin Biol 2024; 31:3-6. [PMID: 37865157 DOI: 10.1016/j.tracli.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION The World Health Organization has advocated that every country should make its own policy for ensuring safe and adequate supply of plasma derived medicinal products through mobilization and usage of locally collected plasma. The National Plasma Policy (NPP) of India was published in 2014 with a dual objective to achieve self sufficiency in the production of plasma derived medicinal products and at the same time to augment the component preparation facilities in India and overall upliftment of blood transfusion services in the country. Thus the present study was done to access the impact of implementation of NPP in our blood bank on the blood transfusion services in our hospital. MATERIALS AND METHODS The present study was a retrospective observational study conducted in the department of transfusion medicine of a tertiary care hospital in India involving analysis of data from 1st January 2019 till 31st December 2022. For the purpose of data analysis the time period was divided into 2 periods: (i) Pre-NPP implementation period from 1st January 2019 till 31st December 2020; (ii) Post-NPP period from 1st January 2021 till 31st December 2022. The following parameters were compared for the two periods: (i) component preparation rate; (ii) percentage of component therapy; (iii) total number of FFP transferred to plasma fractionation centers; (iv) total amount of exchange amount generated in lieu of transferred FFP to plasma fractionation centers. RESULTS The component preparation rate after NPP implementation was significantly higher as compared to the pre NPP implementation period (93.81% vs 56.70%; p = 0.007). The percentage of component therapy in the patients was also significantly higher as compared to the pre-NPP implementation period (97.9% vs 73.6%; p = 0.005). The total amount of exchange amount generation in Indian rupee (INR) after NPP implementation was INR 1419462 (15835€) while it was INR 636898 (7105€) in the pre NPP implementation period. This amount was utilized for procurement of various blood bank equipment, in addition 2 lab technicians were also hired for the blood bank. CONCLUSIONS The implementation of NPP resulted in upliftment of blood transfusion services in our hospital. Other low and middle income countries can benefit from implementation of similar plasma policy in their countries.
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Affiliation(s)
- Naveen Bansal
- Department of Transfusion Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India.
| | - Kajal Khajuria
- Department of Transfusion Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Rajbir Kaur Cheema
- Department of Transfusion Medicine, MM College of Medical Sciences and Research, Sadopur, Ambala, Haryana, India
| | - Ashish Sharma
- Department of Transfusion Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Baltaran Singh Bajwa
- MBBS Student, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Smid WM, Thijssen-Timmer DC. Safeguarding plasma for fractionation: How can we deal with operational challenges in European Union countries. Vox Sang 2024; 119:128-130. [PMID: 37986695 DOI: 10.1111/vox.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Willem Martin Smid
- Sanquin Blood Supply, Amsterdam, The Netherlands
- Academic Institute for International Development of Transfusion Medicine, Groningen, The Netherlands
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Choi CW, Choi Y, Maryuningsih YS, Wibisono B, Kim JW, Ramondrana D, Mizukami T, Ochiai M, Samat AA, Mangorangca C, Thi DL, Van HP, Shim SB, Seong SK, Shin IS. Report for the Eighth Asian National Control Laboratory Network meeting in 2023: Self-sufficiency strategy of plasma-derived medicinal products and regulatory harmonisation. Biologicals 2024; 85:101754. [PMID: 38428357 PMCID: PMC11004723 DOI: 10.1016/j.biologicals.2024.101754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/27/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
The Eighth Asian National Control Laboratory (NCL) Network meeting, entitled "Biological Products Quality Control and Self-Sufficiency Strategy focusing on plasma-derived medicinal products (PDMPs)" was held in Seoul on 31 August 2023. The participants were NCL experts from Indonesia, Japan, Malaysia, the Philippines, Vietnam, and the Republic of Korea. Special lectures included the PDMPs self-sufficiency strategies of the World Health Organization (WHO) and Indonesian Food and Drug Authority, and a case study on Global Benchmarking Tool (GBT) assessment for vaccines by the Korea Ministry of Food and Drug Safety. The NCL delegates shared their current experiences with national lot releases and biological standardisation. The meeting contributed to a mutual understanding of the progress of the PDMPs self-sufficiency among Asian countries, the WHO's support strategies, and the NCL's plan for the preparation of the WHO GBT assessment. In the panel discussion, all participants agreed that building capacity in blood safety in the Asian region and harmonisation of relevant international regulatory requirements will support appropriate emergency preparedness, particularly source materials in the region, and will build the foundation for resolving the PDMPs supply insecurity that has worsened after the COVID-19 pandemic in some countries.
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Affiliation(s)
- Chan Woong Choi
- Blood Products Division, Biopharmaceutical & Herbal Medicine Evaluation Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, South Korea
| | - Youngju Choi
- Biopharmaceutical & Herbal Medicine Evaluation Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, South Korea
| | - Yuyun Siti Maryuningsih
- Blood and Other Product of Human Origin, Health Products Policy and Standards Department, World Health Organization Headquarters, Geneva, Switzerland
| | - Bayu Wibisono
- Indonesian Food and Drug Authority, Jakarta, Indonesia
| | - Jong Won Kim
- Vaccines Division, Biopharmaceutical & Herbal Medicine Evaluation Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, South Korea
| | | | | | - Masaki Ochiai
- National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Caren Mangorangca
- Food and Drug Administration Philippines, Muntinlupa City, Philippines
| | - Dung Luu Thi
- National Institute for Control of Vaccines and Biologicals, Ha Noi, Viet Nam
| | - Hung Pham Van
- National Institute for Control of Vaccines and Biologicals, Ha Noi, Viet Nam
| | - Sun Bo Shim
- Blood Products Division, Biopharmaceutical & Herbal Medicine Evaluation Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, South Korea
| | - Su Kyoung Seong
- Blood Products Division, Biopharmaceutical & Herbal Medicine Evaluation Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, South Korea
| | - In Soo Shin
- Blood Products Division, Biopharmaceutical & Herbal Medicine Evaluation Department, National Institute of Food and Drug Safety Evaluation, Ministry of Food and Drug Safety, Cheongju, South Korea.
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Burnouf T, Epstein J, Faber JC, Smid WM. Stepwise options for preparing therapeutic plasma proteins from domestic plasma in low- and middle-income countries. Vox Sang 2024; 119:102-109. [PMID: 37872819 DOI: 10.1111/vox.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 10/25/2023]
Abstract
Industrial plasma fractionation, a complex and highly regulated technology, remains largely inaccessible to many low- and middle-income countries (LMICs). This, combined with the limited availability and high cost of plasma-derived medicinal products (PDMPs), creates deficiency of access to adequate treatment for patients in resource-limited countries, and leads to their suffering. Meanwhile, an increasing number of LMICs produce surplus plasma, as a by-product of red blood cell preparation from whole blood, that is discarded because of the lack of suitability for fractionation. This article reviews pragmatic technological options for processing plasma collected from LMICs into therapies and supports a realistic stepwise approach aligned with recent World Health Organization guidance and initiatives launched by the Working Party for Global Blood Safety of the International Society of Blood Transfusion. When industrial options based on contract or toll plasma fractionation programme and, even more, domestic fractionation facilities require larger volumes of quality plasma than is produced, alternative methods should be considered. In-bag minipool or small-scale production procedures implementable in blood establishments or national service centres are the only realistic options available to gradually reduce plasma wastage, provide safer treatments for patients currently treated with non-pathogen-reduced blood products and concurrently improve Good Manufacturing Practice (GMP) levels with minimum capital investment. As a next step, when the available volume of quality-assured plasma reaches the necessary thresholds, LMICs could consider engaging with an established fractionator in a fractionation agreement or a contract in support of a domestic fractionation facility to improve the domestic PDMP supply and patients' treatment.
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Affiliation(s)
- Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | | | - Jean-Claude Faber
- Association Luxembourgeoise des Hémophiles, Luxembourg City, Luxembourg
| | - W Martin Smid
- Sanquin Consulting Services, Amsterdam and Academic Institute IDTM, Groningen, The Netherlands
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Merz EM. The availability of plasma donors and plasma: A sociologist's perspective. Vox Sang 2024; 119:131-133. [PMID: 38226559 DOI: 10.1111/vox.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Eva-Maria Merz
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Center for Philanthropic Studies, Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Leu JH, Vermeulen A, Abbes C, Arroyo S, Denney WS, Ling LE. Pharmacokinetics and pharmacodynamics across infusion rates of intravenously administered nipocalimab: results of a phase 1, placebo-controlled study. Front Neurosci 2024; 18:1302714. [PMID: 38362023 PMCID: PMC10867144 DOI: 10.3389/fnins.2024.1302714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Nipocalimab is a high-affinity, fully human, aglycosylated, effectorless, immunoglobulin G (IgG) 1 monoclonal antibody that targets the neonatal Fc receptor (FcRn), decreases systemic IgG including autoantibodies, and is under development in several IgG autoantibody- and alloantibody-mediated diseases, including generalized myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, maternal-fetal medicine, and multiple other therapeutic areas. An initial phase 1 study with single and multiple ascending doses of nipocalimab infused intravenously (IV) over 2 h demonstrated dose-dependent serum pharmacokinetics and IgG reductions, with an adverse event (AE) profile comparable to placebo. Methods The current investigation evaluates the safety, tolerability, pharmacokinetics, and pharmacodynamics of single doses of nipocalimab across various IV infusion rates in a randomized, double-blind, placebo-controlled, sequential-dose study. Forty participants were randomized to receive nipocalimab 30 mg/kg over 60, 30, 15 or 7.5 min (0.5, 1, 2, or 4 mg/kg/min); nipocalimab 60 mg/kg over 15 min (4 mg/kg/min); or matching placebo. Results At doses up to 60 mg/kg and infusion rates up to 4 mg/kg/min (maximum clinically feasible rate), single doses of nipocalimab were tolerable, with 12 (40%) participants experiencing AEs across nipocalimab cohorts compared with 1 (10%) participant in the placebo cohort. AEs deemed treatment related occurred in 6 (20%) participants receiving nipocalimab and 1 (10%) participant receiving placebo. None of the AEs were severe, and no participants discontinued treatment due to AEs. Nipocalimab provided consistent, dose-dependent serum pharmacokinetics and IgG reductions, regardless of infusion rate. Discussion This study supports the use of shortened durations of nipocalimab infusion for future studies.
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Affiliation(s)
- Jocelyn H. Leu
- Janssen Research & Development, LLC, Spring House, PA, United States
| | - An Vermeulen
- Janssen Research & Development, LLC, a Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Claudia Abbes
- Momenta Pharmaceuticals, Inc., Cambridge, MA, United States
| | | | | | - Leona E. Ling
- Janssen Research & Development, LLC, Cambridge, MA, United States
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11
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Anwendung von humanen Immunglobulinpräparaten bei Lieferengpässen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1184-1189. [PMID: 37768373 DOI: 10.1007/s00103-023-03759-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
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12
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Saltzmann C. How to convert whole‐blood donors to plasma donors: An investigation of the mechanisms of awareness of need for plasma and donors' perception of response efficacy. Transfusion 2023; 63:1023-1043. [PMID: 37002707 DOI: 10.1111/trf.17316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Blood donation services need to increase plasma donations to match the rising demand. However, evidence on how to best recruit donors among whole-blood donors is limited. Therefore, this study evaluated the effectiveness of a conversion strategy based on two different mechanisms that drive donor behavior: (a) awareness of the need for plasma donation and (b) perception of response efficacy regarding plasma donation. STUDY DESIGN AND METHODS An online experiment with 246 German Red Cross whole-blood donors (possibility of plasma donation, blood group AB) was conducted using a 2 × 2 factorial, between-subject setup, and a pre-post treatment measurement. The mechanisms varied and were addressed with experimental treatments and measured. Analyses of variance and hierarchical regression models were used to analyze the effects on intention and behavior. RESULTS The intention to donate plasma was low, but increased with treatment (mean valueoverall of intentionbeforeTreatment = 2.63, SD = 1.73 vs. intentionafterTreatment = 3.28, SD = 1.92). Furthermore, 31% of participants expressed willingness to be forwarded to the appointment-scheduling system of the blood donation service for further information. Only the mechanism of response efficacy was significantly associated with the intention to donate plasma (βEfficacy = .254, p = .001; βAwareness of Need = .126, p = .070). DISCUSSION A conversion strategy based on making donors aware of their response efficacy is a promising way to optimize donor panels by shifting them to where they have the greatest impact. However, this study also substantiates the difficulty of such an effort. Blood donation services should invest in persuasion efforts and build personalized integrated marketing communications.
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Affiliation(s)
- Carolin Saltzmann
- Faculty of Business, Economics and Social Sciences, Research Group on Health Marketing Universität Hamburg Von‐Melle‐Park 9 D‐20146 Hamburg Germany
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13
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Implementing strategic plasma resource self-sufficiency through unpaid plasma donations on the global plasma market. Transfus Clin Biol 2023; 30:179-182. [PMID: 36828233 DOI: 10.1016/j.tracli.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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14
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Langi Sasongko P, van Kraaij M, So‐Osman C. Using a scenario approach to assess for the current and future demand of immunoglobulins: An interview and literature study from The Netherlands. Transfus Med 2022; 32:410-421. [PMID: 35751376 PMCID: PMC9795925 DOI: 10.1111/tme.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To explore the current and future demand of immunoglobulins globally and specifically for the Netherlands by assessing: (I) which specialties contribute to current demand, (II) new areas of medical need, (III) which transformational factors may impact demand and to what effect, by using a scenario approach. BACKGROUND As immunoglobulin demand continues to increase globally, there is concern of increasing shortages and questions of whether and how future demand will continue based on medical need. METHODS/MATERIALS In line with scenario principles, a scoping review of Pubmed, Web of Science, Embase and Cochrane and grey literature was conducted. Semi-structured interviews with subject matter experts were held. The results of the review and interviews were analysed for major themes. RESULTS The scoping review resulted in 97 articles, 74 regarding clinical uses, and 23 regarding organisational and other themes. Fifteen clinical and non-clinical experts were interviewed. I) Neurology, immunology, and haematology were specialties that contribute most to current demand. II) Regarding potential new areas of medical need, the literature review resulted in more indications than the interviews, for example, post-renal transplants. III) Four groups of key transformational factors were found: factors that could increase immunoglobulin demand (e.g., EMA revisions), decrease demand (e.g., replacement products, Dutch Transfer Act 2021), factors that remain to be seen how it impacts demand (e.g., further evidence), and miscellaneous factors (e.g., supply-related). CONCLUSION Having identified the specialties and relevant transformational factors that affect immunoglobulin demand, more research is needed on what clinical or organisational strategies would be effective in controlling demand in general for the Netherlands and abroad. Other blood establishments may also use a scenario approach to increase preparedness for future (un)expected developments.
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Affiliation(s)
- Praiseldy Langi Sasongko
- Department of Donor Medicine ResearchUnits Transfusion Technology Assessment and Donor Studies, Sanquin ResearchAmsterdamThe Netherlands,Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Cynthia So‐Osman
- Department of Unit Transfusion MedicineSanquin Blood BankAmsterdamThe Netherlands,Department of HaematologyErasmus Medical CenterRotterdamThe Netherlands
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15
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Khandelwal A, Minuk L, Liu Y, Arnold DM, Heddle NM, Barty R, Hsia C, Solh Z, Shehata N, Thompson T, Tinmouth A, Perelman I, Skeate R, Kron AT, Callum J. Plasma transfusion practices: A multicentre electronic audit. Vox Sang 2022; 117:1211-1219. [PMID: 36102150 DOI: 10.1111/vox.13355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Plasma is often transfused to patients with bleeding or requiring invasive procedures and with abnormal tests of coagulation. Chart audits find half of plasma transfusions unnecessary, resulting in avoidable complications and costs. This multicentre electronic audit was conducted to determine the proportion of plasma transfused without an indication and/or at a sub-therapeutic dose. METHODS Data were extracted on adult inpatients in 2017 at five academic sites from the hospital electronic chart, laboratory information systems and the Canadian Institute for Health Information Discharge Abstract Database. Electronic criteria for plasma transfusion outside recommended indications were: (1) international normalized ratio (INR) < 1.5 with no to moderate bleeding; (2) INR ≥ 1.5, with no to mild bleeding and no planned procedures; and (3) no INR before or after plasma infusion. Sub-therapeutic dose was defined as ≤2 units transfused. RESULTS In 1 year, 2590 patients received 6088 plasma transfusions encompassing 11,490 units of plasma occurred at the five sites. 77.7% of events were either outside indications or under-dosed. Of these, 34.8% of plasma orders had no indication identified, and 62% of these occurred in non-bleeding patients and no planned procedure with an isolated elevated INR. 70.7% of transfusions were under-dosed. Most plasma transfusions occurred in the intensive care unit or the operating room. Inter-hospital variability in peri-transfusion testing and dosing was observed. CONCLUSION The majority of plasma transfusions are sub-optimal. Local hospital culture may be an important driver. Electronic audits, with definitions employed in this study, may be a practical alternative to costly chart audits.
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Affiliation(s)
- Aditi Khandelwal
- Canadian Blood Services, Toronto, Ontario, Canada.,The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Leigh Minuk
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yang Liu
- McMaster Centre for Transfusion Research (MCTR), McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research (MCTR), McMaster University, Hamilton, Ontario, Canada.,Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- McMaster Centre for Transfusion Research (MCTR), McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Barty
- McMaster Centre for Transfusion Research (MCTR), McMaster University, Hamilton, Ontario, Canada.,Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
| | - Cyrus Hsia
- Department of Medicine, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Transfusion Medicine Laboratories, London Health Sciences Centre, London, Ontario, Canada
| | - Ziad Solh
- Department of Medicine, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Transfusion Medicine Laboratories, London Health Sciences Centre, London, Ontario, Canada
| | - Nadine Shehata
- The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Troy Thompson
- Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
| | - Alan Tinmouth
- Ottawa Hospital Centre for Transfusion Research, Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Iris Perelman
- Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Robert Skeate
- Canadian Blood Services, Toronto, Ontario, Canada.,The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada
| | - Amie T Kron
- The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada.,Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeannie Callum
- The University of Toronto Quality in Utilization, Education and Safety in Transfusion (QUEST) Research Program, Toronto, Ontario, Canada.,Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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16
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Mornex JF, Balduyck M, Bouchecareilh M, Cuvelier A, Epaud R, Kerjouan M, Le Rouzic O, Pison C, Plantier L, Pujazon MC, Reynaud-Gaubert M, Toutain A, Trumbic B, Willemin MC, Zysman M, Brun O, Campana M, Chabot F, Chamouard V, Dechomet M, Fauve J, Girerd B, Gnakamene C, Lefrançois S, Lombard JN, Maitre B, Maynié-François C, Moerman A, Payancé A, Reix P, Revel D, Revel MP, Schuers M, Terrioux P, Theron D, Willersinn F, Cottin V, Mal H. [French clinical practice guidelines for the diagnosis and management of lung disease with alpha 1-antitrypsin deficiency]. Rev Mal Respir 2022; 39:633-656. [PMID: 35906149 DOI: 10.1016/j.rmr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Affiliation(s)
- J-F Mornex
- Université de Lyon, université Lyon 1, INRAE, EPHE, UMR754, IVPC, 69007 Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares, hospices civils de Lyon, hôpital Louis-Pradel, service de pneumologie, 69500 Bron, France.
| | - M Balduyck
- CHU de Lille, centre de biologie pathologie, laboratoire de biochimie et biologie moléculaire HMNO, faculté de pharmacie, EA 7364 RADEME, université de Lille, service de biochimie et biologie moléculaire, Lille, France
| | - M Bouchecareilh
- Université de Bordeaux, CNRS, Inserm U1053 BaRITon, Bordeaux, France
| | - A Cuvelier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, Rouen, France; Groupe de recherche sur le handicap ventilatoire et neurologique (GRHVN), université Normandie Rouen, Rouen, France
| | - R Epaud
- Centre de références des maladies respiratoires rares, site de Créteil, Créteil, France
| | - M Kerjouan
- Service de pneumologie, CHU Pontchaillou, Rennes, France
| | - O Le Rouzic
- CHU Lille, service de pneumologie et immuno-allergologie, Lille, France; Université de Lille, CNRS, Inserm, institut Pasteur de Lille, U1019, UMR 9017, CIIL, OpInfIELD team, Lille, France
| | - C Pison
- Service de pneumologie physiologie, pôle thorax et vaisseaux, CHU de Grenoble, Grenoble, France; Université Grenoble Alpes, Saint-Martin-d'Hères, France
| | - L Plantier
- Service de pneumologie et explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France; Université de Tours, CEPR, Inserm UMR1100, Tours, France
| | - M-C Pujazon
- Service de pneumologie et allergologie, pôle clinique des voies respiratoires, hôpital Larrey, Toulouse, France
| | - M Reynaud-Gaubert
- Service de pneumologie, centre de compétence pour les maladies pulmonaires rares, AP-HM, CHU Nord, Marseille, France; Aix-Marseille université, IHU-Méditerranée infection, Marseille, France
| | - A Toutain
- Service de génétique, CHU de Tours, Tours, France; UMR 1253, iBrain, université de Tours, Inserm, Tours, France
| | | | - M-C Willemin
- Service de pneumologie et oncologie thoracique, CHU d'Angers, hôpital Larrey, Angers, France
| | - M Zysman
- Service de pneumologie, CHU Haut-Lévèque, Bordeaux, France; Université de Bordeaux, centre de recherche cardiothoracique, Inserm U1045, CIC 1401, Pessac, France
| | - O Brun
- Centre de pneumologie et d'allergologie respiratoire, Perpignan, France
| | - M Campana
- Service de pneumologie, CHR d'Orléans, Orléans, France
| | - F Chabot
- Département de pneumologie, CHRU de Nancy, Vandœuvre-lès-Nancy, France; Inserm U1116, université de Lorraine, Vandœuvre-lès-Nancy, France
| | - V Chamouard
- Service pharmaceutique, hôpital cardiologique, GHE, HCL, Bron, France
| | - M Dechomet
- Service d'immunologie biologique, centre de biologie sud, centre hospitalier Lyon Sud, HCL, Pierre-Bénite, France
| | - J Fauve
- Cabinet médical, Bollène, France
| | - B Girerd
- Université Paris-Saclay, faculté de médecine, Le Kremlin-Bicêtre, France; AP-HP, centre de référence de l'hypertension pulmonaire, service de pneumologie et soins intensifs respiratoires, hôpital Bicêtre, Le Kremlin-Bicêtre, France; Inserm UMR_S 999, hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - C Gnakamene
- Service de pneumologie, CH de Montélimar, GH Portes de Provence, Montélimar, France
| | | | | | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal, Créteil, France; Inserm U952, UFR de santé, université Paris-Est Créteil, Créteil, France
| | - C Maynié-François
- Université de Lyon, collège universitaire de médecine générale, Lyon, France; Université Claude-Bernard Lyon 1, laboratoire de biométrie et biologie évolutive, UMR5558, Villeurbanne, France
| | - A Moerman
- CHRU de Lille, hôpital Jeanne-de-Flandre, Lille, France; Cabinet de médecine générale, Lille, France
| | - A Payancé
- Service d'hépatologie, CHU Beaujon, AP-HP, Clichy, France; Filière de santé maladies rares du foie de l'adulte et de l'enfant (FilFoie), CHU Saint-Antoine, Paris, France
| | - P Reix
- Service de pneumologie pédiatrique, allergologie, mucoviscidose, hôpital Femme-Mère-Enfant, HCL, Bron, France; UMR 5558 CNRS équipe EMET, université Claude-Bernard Lyon 1, Villeurbanne, France
| | - D Revel
- Université Claude-Bernard Lyon 1, Lyon, France; Hospices civils de Lyon, Lyon, France
| | - M-P Revel
- Université Paris Descartes, Paris, France; Service de radiologie, hôpital Cochin, AP-HP, Paris, France
| | - M Schuers
- Université de Rouen Normandie, département de médecine générale, Rouen, France; Sorbonne université, LIMICS U1142, Paris, France
| | | | - D Theron
- Asten santé, Isneauville, France
| | | | - V Cottin
- Université de Lyon, université Lyon 1, INRAE, EPHE, UMR754, IVPC, 69007 Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares, hospices civils de Lyon, hôpital Louis-Pradel, service de pneumologie, 69500 Bron, France
| | - H Mal
- Service de pneumologie B, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France; Inserm U1152, université Paris Diderot, site Xavier Bichat, Paris, France
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17
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Burnouf T, Epstein J, Faber JC, Tayou Tagny C, Somuah D, Smid WM. Rationale for supporting stepwise access to safe plasma proteins through local production in low- and middle-income countries: A commentary of an international workshop. Biologicals 2022; 79:27-30. [DOI: 10.1016/j.biologicals.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/21/2022] [Indexed: 11/02/2022] Open
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18
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Hartmann J, Ragusa MJ, Manukyan Z, Popovsky MA. Timing of hypotensive adverse events in U.S. source plasma donors: exploratory analysis from the IMproving PlasmA CollecTion (IMPACT) trial. Transfus Apher Sci 2022; 61:103470. [DOI: 10.1016/j.transci.2022.103470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022]
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19
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Shortage of plasma-derived products: a looming crisis? Blood 2022; 139:3222-3225. [PMID: 35259239 DOI: 10.1182/blood.2021015370] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/19/2022] [Indexed: 11/20/2022] Open
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20
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Mishra S, Flanagan P, Frampton C. Utilisation of immunoglobulin in New Zealand. Intern Med J 2022. [PMID: 35049107 DOI: 10.1111/imj.15694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/08/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immunoglobulin is an expensive and scarce resource and usage is increasing worldwide. Immunoglobulin is used to treat a variety of clinical conditions, particularly primary and acquired immunodeficiencies and immune mediated neurological disorders. As immunoglobulin usage continues to increase, plasma collection must increase accordingly in order to sustain immunoglobulin production. The New Zealand Blood Service (NZBS) is the provider of immunoglobulin in New Zealand (NZ). Information regarding national immunoglobulin usage warrants analysis given the rise in usage. AIMS We set out to review immunoglobulin usage in NZ with a focus on the trend in the amount used, number of patients, clinical indications and compliance with international guidelines. A comparison with international immunoglobulin usage was performed. The impact on national plasma collection was reviewed. METHODS Data on immunoglobulin usage, number of patients, and plasma collection over the past decade was obtained from the NZBS Tableau database. Data from international literature was reviewed. RESULTS Immunoglobulin usage in NZ has been increasing over the past decade, with an annual growth rate of 6.4%. The three main indications for immunoglobulin are primary immunodeficiency disorders, chronic inflammatory demyelinating polyneuropathy (CIDP), and acquired hypogammaglobulinaemia secondary to haematological malignancies. Prominent growth in usage is evident for CIDP and acquired hypogammaglobulinaemia. Immunoglobulin usage in NZ is low compared other countries such as Australia and the United States. There has been a marked increase in plasma donations in order to keep up with immunoglobulin demand. CONCLUSIONS Immunoglobulin is a strategic resource and appropriate usage is critical to regulate demand. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sonam Mishra
- Transfusion Medicine Fellow New Zealand Blood Service 15 Lester Lane, Addington, Christchurch, New Zealand
| | - Peter Flanagan
- Transfusion Medicine Specialist New Zealand Blood Service, Wellington, New Zealand
| | - Chris Frampton
- Biostatistician University of Otago, Christchurch, New Zealand
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21
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Cho JH, Hiskey M. Plasmavigilance: Source plasma joins the call to arms. Transfusion 2021; 61:2803-2805. [PMID: 34605562 DOI: 10.1111/trf.16668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph H Cho
- Secure Transfusion Services, Medical Affairs, South San Francisco, California, USA
| | - Matthew Hiskey
- Versiti, Medical Sciences Institute, Milwaukee, Wisconsin, USA
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22
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Tiberghien P. Increasing unpaid plasma collection by blood establishments to ensure availability of plasma-derived medicinal products and blood components in Europe. Transfus Clin Biol 2021; 28:331-333. [PMID: 34506941 DOI: 10.1016/j.tracli.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Tiberghien
- European Blood Alliance, Bruxelles, Belgique; Établissement Français du Sang, La Plaine St-Denis, France; Université de Franche-Comté, Besançon, France.
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23
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Hartmann J, Ragusa MJ, Burchardt ER, Manukyan Z, Popovsky MA, Leitman SF. Repeat donation and deferral rates in US source plasma donors: Exploratory analysis from the IMPACT trial. Transfusion 2021; 61:2849-2854. [PMID: 34309028 PMCID: PMC9290731 DOI: 10.1111/trf.16610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 11/30/2022]
Abstract
Background The IMPACT trial demonstrated the safety of a new personalized nomogram for plasma donation and provided an opportunity to explore short‐ to mid‐term impact on repeat donation and deferral rates, and factors affecting these. Study Design and Methods In the IMPACT trial, participants were randomized to donate plasma using an established weight‐based nomogram (control) versus a new personalized nomogram incorporating height, weight, and hematocrit (experimental). In this exploratory analysis, repeat donations (per donor, by study arm) were analyzed using negative binomial generalized linear regression models and descriptive statistics. The mean number of donor deferral events was compared between the two arms using logistic regression and count data modeling approaches and were analyzed by lead cause. Results The predicted mean number of repeat donations was similar between the control and experimental arms (6.82 vs. 6.62, respectively; p = .22). Overall, the predicted mean number of repeat donations was significantly higher in males compared with females (p < .0001). Naïve donors had on average 2.8/2.7 (control/experimental) fewer repeat donations compared with experienced donors. In 23, 137 donations from 3443 donors, 798 donors (376 control, 422 experimental, p = .80) had at least one deferral (for any cause). The predicted mean number of deferrals in all categories of interest was not statistically different between the study arms. Conclusion Similar repeat donation and deferral rates between arms suggest that the new nomogram did not result in disruptions to subsequent donation. Further longitudinal research on mid‐ to long‐term effects is warranted.
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Affiliation(s)
- Jan Hartmann
- Haemonetics Corporation, Boston, Massachusetts, USA
| | | | | | | | | | - Susan F Leitman
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
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24
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Hartmann J, Ragusa MJ, Burchardt ER, Manukyan Z, Popovsky MA, Leitman SF. Personalized collection of plasma from healthy donors: A randomized controlled trial of a novel technology-enabled nomogram. Transfusion 2021; 61:1789-1798. [PMID: 33760230 PMCID: PMC8251497 DOI: 10.1111/trf.16389] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 01/26/2023]
Abstract
Background Source plasma is essential to support the growing demand for plasma‐derived medicinal products. Supply is short, with donor availability further limited by the coronavirus disease 2019 (COVID‐19) pandemic. This study examined whether a novel, personalized, technology‐based nomogram was noninferior with regard to significant hypotensive adverse events (AEs) in healthy donors. Study Design and Methods IMPACT (IMproving PlasmA CollecTion) was a prospective, multicenter, double‐blinded, randomized, controlled trial carried out between January 6 and March 26, 2020, in three U.S plasma collection centers. Donors were randomly assigned to the current simplified 1992 nomogram (control) or a novel percent plasma nomogram (PPN) with personalized target volume calculation (experimental). Primary endpoint was the rate of significant hypotensive AEs. Noninferiority (NI) was tested with a margin of 0.15%. Collected plasma volume was a secondary endpoint. Results A total of 3443 donors (mean [SD] BMI: 32 [7.74] kg/m2; 65% male) underwent 23,137 donations (median [range]: 6 [1–22] per subject). Ten significant hypotensive AEs were observed (six control; four experimental), with model‐based AE incidence rate estimates (95% CI) of 0.051% (0.020%–0.114%) and 0.035% (0.010%–0.094%), respectively (p = .58). NI was met at an upper limit of 0.043% versus the predefined margin of 0.15%. There was no statistical difference between total AEs (all AE types: p = .32). Mean plasma volume collected was 777.8 ml (control) versus 841.7 ml (experimental); an increase of 63.9 ml per donation (8.2%; p < .0001). Conclusion This trial showed that a novel personalized nomogram approach in healthy donors allowed approximately 8% more plasma per donation to be collected without impairing donor safety.
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Affiliation(s)
- Jan Hartmann
- Haemonetics Corporation, Boston, Massachusetts, USA
| | | | | | | | | | - Susan F Leitman
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
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25
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Brand A, De Angelis V, Vuk T, Garraud O, Lozano M, Politis D. Review of indications for immunoglobulin (IG) use: Narrowing the gap between supply and demand. Transfus Clin Biol 2021; 28:96-122. [DOI: 10.1016/j.tracli.2020.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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26
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Editorial. Transfus Clin Biol 2021; 28:3-4. [PMID: 33423949 DOI: 10.1016/j.tracli.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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Farrugia A. The interphase between immunoglobulin, the plasma industry and the public health, managing a finite resource. Transfus Clin Biol 2020; 28:86-88. [PMID: 33358661 DOI: 10.1016/j.tracli.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Albert Farrugia
- School of Surgery, Faculty of Medicine and Medical Sciences, The University of Western Australia, 35, Stirling Highway, Crawley, WA, 6009, Australia.
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28
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Hartmann J, Klein HG. Supply and demand for plasma-derived medicinal products - A critical reassessment amid the COVID-19 pandemic. Transfusion 2020; 60:2748-2752. [PMID: 32856742 PMCID: PMC7460929 DOI: 10.1111/trf.16078] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Jan Hartmann
- Department of Medical Affairs and Clinical Development, Haemonetics Corporation, Boston, Massachusetts, USA
| | - Harvey G Klein
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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29
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Peter HH, Ochs HD, Cunningham-Rundles C, Vinh DC, Kiessling P, Greve B, Jolles S. Targeting FcRn for immunomodulation: Benefits, risks, and practical considerations. J Allergy Clin Immunol 2020; 146:479-491.e5. [PMID: 32896308 PMCID: PMC7471860 DOI: 10.1016/j.jaci.2020.07.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 02/08/2023]
Abstract
The neonatal fragment crystallizable (Fc) receptor (FcRn) functions as a recycling mechanism to prevent degradation and extend the half-life of IgG and albumin in the circulation. Several FcRn inhibitors selectively targeting IgG recycling are now moving rapidly toward clinical practice in neurology and hematology. These molecules accelerate the destruction of IgG, reducing pathogenic IgG and IgG immune complexes, with no anticipated effects on IgA, IgM, IgE, complement, plasma cells, B cells, or other cells of the innate or adaptive immune systems. FcRn inhibitors have potential for future use in a much wider variety of antibody-mediated autoimmune diseases. Given the imminent clinical use, potential for broader utility, and novel mechanism of action of FcRn inhibitors, here we review data from 4 main sources: (a) currently available activity, safety, and mechanism-of-action data from clinical trials of FcRn inhibitors; (b) other procedures and treatments that also remove IgG (plasma donation, plasma exchange, immunoadsorption); (c) diseases resulting in loss of IgG; and (d) primary immunodeficiencies with potential mechanistic similarities to those induced by FcRn inhibitors. These data have been evaluated to provide practical considerations for the assessment, monitoring, and reduction of any potential infection risk associated with FcRn inhibition, in addition to highlighting areas for future research.
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Affiliation(s)
- Hans-Hartmut Peter
- Freiburg University Hospital, Centre for Chronic Immunodeficiency, Freiburg, Germany
| | - Hans D Ochs
- Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash
| | | | - Donald C Vinh
- Division of Infectious Diseases, Department of Medicine and Department of Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada; Infectious Diseases & Immunity in Global Health Program, Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom.
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Shaz BH, Domen RE, France CR. Remunerating donors to ensure a safe and available blood supply. Transfusion 2019; 60 Suppl 3:S134-S137. [DOI: 10.1111/trf.15647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | - Ronald E. Domen
- Penn State College of Medicine and Hershey Medical Center Hershey Pennsylvania
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The growing importance of achieving national self-sufficiency in immunoglobulin in Italy. The emergence of a national imperative. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:449-458. [PMID: 31846609 DOI: 10.2450/2019.0265-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/14/2019] [Indexed: 12/17/2022]
Abstract
Since the inception of industrial plasma fractionation during the Second World War, a succession of protein therapies isolated from plasma have determined the volume of plasma requiring collection, and have also shaped the economics of the industry. These so-called plasma drivers have successively included albumin, coagulation Factor VIII (FVIII) and, for the past thirty years, intravenously (IV) and subcutaneously (SC) administered immunoglobulin (IG) solutions. The sale of IG underpins the profitability of the industry and has experienced continuous growth over the past decades, as the result of growing clinical demand. Modelling this demand using decision analysis indicates that supplying the evidence-based indications for IG therapies will generate a need for IG which exceeds the current plasma collection capacity of most countries. A notable exception to this situation is the United States (US) of America, whose population of compensated plasma donors generates two thirds of the global supply of plasma for fractionation. The US is also the leading consumer of IG, and its health care providers pay the highest price for the product globally. Shortages of IG occur whenever the demand for the product outstrips the supply. Current shortages, following other historical periods of shortage, threaten the well-being of patients dependant on these products and incur heavy costs on health systems. In Italy, the national blood system, which is based on voluntary unpaid donors, reflects a policy of national self-sufficiency in blood-derived therapies (a strategic objective of the national blood system itself), based on solidarity as an ethical principle. This system has increased the collection of plasma for fractionation by 3.8% per annum over 2008-2017, in accordance to a plan for plasma procurement targeting a collection rate of 14.1 L of plasma per thousand (103) population by 2020. Over the same period, IG usage has increased by 8.5/per annum, to 89.2 g IG/103 population. In this paper, we review the factors which, increasingly, are causing an imbalance between the global supply and demand for IG, and we assess Italy's capacity to ensure that increasing this level of independence is no longer simply an ethical, but also an economic imperative, with implications for the security of Italy's health system.
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Samukange WT, Gardarsdottir H, Leufkens HGM, Mantel-Teeuwisse AK. Selection of Blood, Blood Components, and Blood Products as Essential Medicines in 105 Low- and Middle-Income Countries. Transfus Med Rev 2019; 34:94-100. [PMID: 31761652 DOI: 10.1016/j.tmrv.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/03/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
Blood products of human origin are essential treatment options for several diseases, for example, hemophilia. We studied the alignment of national essential medicines lists (NEMLs) of low- and middle-income countries (LMICs) with the World Health Organization (WHO) Model List for the selection of blood products of human origin. The most recent versions of NEMLs from all LMICs were studied for the inclusion of blood products of human origin (blood and blood components, plasma products, and immunoglobulins). Data obtained from 105 NEMLs were compared to the 2017 WHO Model List. The median number of blood products of human origin on the NEMLs was 4 (range: 0-10). Immunoglobulins were most frequently included (73%). Blood and blood components were the least selected products (15%). The uptake of plasma products was around 50%. Nine countries did not have any blood products of human origin on their NEMLs. Some NEMLs included blood products not listed on the WHO Model List (albumin, hepatitis A immunoglobulin, and cryoprecipitate). We observed variation in selection according to WHO region, income level, and year of NEML update. Alignment of NEMLs with the WHO Model List varied greatly for different groups of blood products, ranging from good uptake for immunoglobulins, reasonable uptake for plasma products, to poor uptake for blood and blood components. This heterogeneity in selection and inclusion of blood products of human origin on NEMLs may be partly explained as being due to specific country characteristics, but some of it may not be explained. Policy makers need to rely on evidence in making decisions about which blood products to select, include, and remove on their NEMLs.
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Affiliation(s)
- Washington T Samukange
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands; Paul Ehrlich Institut, Langen, Germany
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands.
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The current and future role of plasma-derived clotting factor concentrate in the treatment of haemophilia A. Transfus Apher Sci 2018; 57:502-506. [DOI: 10.1016/j.transci.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Garraud O, Tissot JD. Blood and Blood Components: From Similarities to Differences. Front Med (Lausanne) 2018; 5:84. [PMID: 29686986 PMCID: PMC5900421 DOI: 10.3389/fmed.2018.00084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/16/2018] [Indexed: 12/17/2022] Open
Abstract
Blood transfusion is made possible because, in most countries and organizations, altruistic individuals voluntarily, anonymously, and generously donate (without compensation) either whole blood or separated components that are then processed and distributed by professionals, prior to being allocated to recipients in need. Being part of modern medicine, blood transfusion uses so-called standard blood components when relative to cellular fractions and fresh plasma. However, as will be discussed in this paper, strictly speaking, such so-called labile blood components are not completely standard. Furthermore, the prevalent system based on voluntary, non-remunerated blood donation is not yet universal and, despite claims by the World Health Organization that 100% of blood collection will be derived from altruistic donations by 2020 (postponed to 2025), many obstacles may hinder this ambition, especially when relative to the collection of the enormous amount of plasma destined for fractionation into plasma derivative or drugs. Finally, country organizations also vary due to the economy, sociology, politics, and epidemiology. This paper then, discusses the particulars (of which ethical considerations) of blood transfusion diversity and the consequences for donors, patients, and society.
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Affiliation(s)
- Olivier Garraud
- Faculty of Medicine, University of Lyon, Saint-Etienne, France
- Institut National de la Transfusion Sanguine, Paris, France
| | - Jean-Daniel Tissot
- Transfusion Interrégionale CRS, Epalinges, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Nixon CP, Tavares MF, Sweeney JD. How do we reduce plasma transfusion in Rhode Island? Transfusion 2017; 57:1863-1873. [PMID: 28681548 DOI: 10.1111/trf.14223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Plasma transfusions are given to patients with coagulopathy, either prophylactically, before an invasive procedure; or therapeutically, in the presence of active bleeding; and as an exchange fluid in therapeutic plasma exchange for disorders such as thrombotic thrombocytopenic purpura. There is consensus that many prophylactic plasma transfusions are non-efficacious, and the misdiagnosis of thrombotic thrombocytopenic purpura results in unnecessary therapeutic plasma exchange. STUDY DESIGN AND METHODS Beginning in 2001, programs to reduce plasma transfusion in the three major teaching hospitals in Rhode Island were initiated. The programs evolved through the establishment of guidelines, education for key prescribers of plasma, screening of plasma prescriptions, and engagement of individual prescribing physicians for out-of-guidelines prescriptions with modification or cancellation. Establishment of an in-house ADAMTS13 (ADAM metallopeptidase with thrombospondin type 1, motif 13) assay in 2013 was used to prevent therapeutic plasma exchange in patients with non-thrombotic thrombocytopenic purpura microangiopathy. Transfusion service data were gathered at the hospital level regarding blood component use, hospital data for discharges, inpatient mortality, and mean case-mix index, and, at the state level, for units of plasma shipped from the community blood center to in-state hospitals. RESULTS Between 2006 and 2016, a reduction in plasma use from 11,805 to 2677 units (a 77% decrease) was observed in the three hospitals and was mirrored in the state as a whole. This decline was not associated with any increase in red blood cell transfusion. Inpatient mortality either declined or was unchanged. CONCLUSION An active program focused on education and interdiction can achieve a large decrease in plasma transfusions without evidence of patient harm.
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Affiliation(s)
- Christian P Nixon
- Transfusion Service, Rhode Island Hospital, Providence, Rhode Island.,Transfusion Service, The Miriam Hospital, Providence, Rhode Island
| | - Maria F Tavares
- Blood Bank, Roger Williams Hospital, Providence, Rhode Island
| | - Joseph D Sweeney
- Transfusion Service, Rhode Island Hospital, Providence, Rhode Island.,Transfusion Service, The Miriam Hospital, Providence, Rhode Island.,Blood Bank, Roger Williams Hospital, Providence, Rhode Island
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