Administering Plasma Therapy Requires Pharmacist Collaboration With a Specialty Care Team

Plasma therapies have been increasingly developed for a variety of unique and life-threatening conditions that previously had no effective therapies available, relieving disease burden for millions of patients. Plasma proteins, including immunoglobulins, clotting factors, and inhibitors such as C1 esterase and α1 proteinase, have been designed to treat immunology-induced immunodeficiencies, neurological conditions, bleeding disorders, liver disease, and myriad other difficult-to-treat diagnoses. With proper dosing and administration, plasma therapies heighten patient life expectancy, prevent infections, and improve quality of life (QOL).¹

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Through plasmapheresis, also called plasma exchange, large amounts of autoantibodies in the patient's plasma are removed and replaced with donated, healthy plasma. The process is used in various autoimmune diseases, including myasthenia gravis, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), Guillain-Barré syndrome, multiple sclerosis, and other rare diseases that generate autoantibodies against the body. Often, patients are treated at specialty infusion centers or hospitals with a diverse team of treatment providers available.²

In this process, pharmacists are an essential component of the specialty care team, ensuring proper dosing of plasma therapies and a successful treatment course for the patient. Pharmacists play a crucial role in counseling the patient on what to expect during the infusion process and how often they should be returning for follow-up with their primary care physician. There may be adverse effects, including changes in blood pressure and risk of an allergic reaction to the newly introduced plasma. If these occur, pharmacists must be prepared to prescribe appropriate therapies to reduce symptoms.³

The arduous plasma exchange process for many patients can take multiple weeks, and pharmacists are critical to the process of working with the patient and their physicians to set up a proper plasma exchange schedule. The dosing should be organized around what the current state of the disease requires but with great consideration given to the needs and ability of the patient to tolerate the procedure. Pharmacists have expert knowledge on medications, how often they should be administered, and at what doses they should be administered, and should therefore be relied upon in this process.

Still, plasma therapies may present a novel field for many pharmacists who are not often involved in specialty conditions such as autoimmune or inflammatory disorders. Often, plasma therapies are infused through an intravenous procedure, which could be difficult to administer and burdensome for the patient. Fortunately, more convenient alternatives to intravenous infusions of plasma are becoming available after review from regulatory authorities, including IgG infusion 10% with recombinant human hyaluronidase (HyQvia; Takeda Pharmaceuticals).⁴

HyQvia has multiple FDA-approved indications, including for the treatment of primary immunodeficiency (PI) in adult and pediatric patients 2 years or older and as maintenance therapy in adults with CIDP. It works as plasma therapy by supplying a wide spectrum of neutralizing IgG antibodies against autoantibodies and viral agents in the body. Critically, for patients who may have reduced QOL due to frequent infusions, HyQvia can be administered subcutaneously once a month.^4-6

“The approval of this new treatment...offers an alternative for health care providers and families who might prefer a less frequent treatment option that can be administered subcutaneously at home, after appropriate training, or in an infusion center,” Jorey Berry, president and CEO of the Immune Deficiency Foundation, said in a news release upon the FDA’s expansion of HyQvia’s indications for PI.⁶

The ability to provide at-home plasma treatment makes pharmacists even more important in educating patients—and themselves—on proper administration of the therapy. Further, although the ability to deliver treatment only once monthly relieves the burden on patients, the gap in time may reduce treatment adherence or lessen patient follow-up. Pharmacists should work to ensure patients continue to return for follow-up evaluations and monitor them for adverse effects.

REFERENCES

1. Plasma. Plasma Protein Therapeutics Association. Accessed February 21, 2025. https://www.pptaglobal.org/plasma#plasma-therapies

2. Therapeutic plasma exchange. University of Texas Southwestern Medical Center. Accessed February 21, 2025. https://utswmed.org/conditions-treatments/apheresis/therapeutic-plasma-exchange/

3. Plasma exchange in immune-mediated neurological conditions. Great Ormond Street Hospital for Children. Updated July 2019. Accessed February 21, 2025. https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/plasma-exchange-immune-mediated-neurological-conditions/

4. HyQvia. FDA. Updated January 16, 2024. Accessed February 21, 2025. https://www.fda.gov/vaccines-blood-biologics/approved-blood-products/hyqvia

5. Arakelians S. Daily medication pearl: HyQvia immune globulin infusion 10%. Pharmacy Times. July 20, 2022. Accessed February 21, 2025. https://www.pharmacytimes.com/view/daily-medication-pearl-hyqvia-immune-globulin-infusion-10-

6. Antrim A. FDA approves expanded indication for HyQvia to treat pediatric primary immunodeficiency. Pharmacy Times. April 12, 2023. Accessed February 21, 2025. https://www.pharmacytimes.com/view/fda-approves-expanded-indication-for-hyqvia-to-treat-pediatric-primary-immunodeficiency