Key Takeaways
- Pharmacists coordinate care across multiple health care disciplines.
- Individualized immunoglobulin therapy selection is crucial.
- Close monitoring of infusion therapies helps mitigate potential adverse effects.
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Expert: Pharmacists' Critical Role in Multidisciplinary CIDP Care
Amy Duong, PharmD, BCACP, highlights pharmacists' essential responsibilities in chronic inflammatory demyelinating polyneuropathy (CIDP) patient care and immunoglobulin therapy management.
In an interview with Pharmacy Times®, Amy Duong, PharmD, BCACP, an ambulatory care clinical pharmacist in neurology at Yale New Haven Health, detailed the comprehensive role pharmacists play in managing chronic inflammatory demyelinating polyneuropathy (CIDP), emphasizing medication management, patient education, and personalized therapy optimization across a multidisciplinary care team.
This is part 1 of a 3-part video series. Stay tuned to Pharmacy Times for more insights.
Pharmacy Times: What are the key responsibilities pharmacists have in the multidisciplinary care of patients with CIDP?
Amy Duong, PharmD, BCACP: As an ambulatory care neurology clinical pharmacist, I play a key role in the multidisciplinary care of our patients with CIDP, mainly focusing on the medication management aspect. I work very closely with our neurologists, nurses, pharmacy technicians, and our authorization team to ensure safe and timely care for our patients. In our comprehensive care clinic that we work out of, our pharmacy technicians play an essential role in reaching out to our patients and assisting with the logistical coordination. For example, by following up on authorization status in collaboration with our authorization team. As a clinical pharmacist, my responsibilities include providing comprehensive medication education on therapies. This can include intravenous immunoglobulin (IVIG), subcutaneous immunoglobulin (SCIg), efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo; Argenx), rituximab (Rituxan; Genentech), and oral steroid tapers as well, which are all commonly used in the treatment of CIDP. I also provide support with logistical aspects of care. This also includes navigation of prior authorizations with our team, coordination of peer-to-peers, writing appeal letters if needed, and coordinating outpatient and home infusions, making sure that those are getting scheduled appropriately. I also provide clinical follow-up assessments with these patients. I will evaluate tolerability, review lab work if needed, and also look at clinical response over time. I'll follow up with patients more closely in the beginning, but as they are stable and they tolerate therapy well, we won't meet as often. Overall, I help ensure that therapy is not only clinically effective but also accessible and sustainable for the patient within a well-coordinated multidisciplinary care model.
Pharmacy Times: How can pharmacists help optimize immunoglobulin therapy and monitor for potential adverse effects in CIDP treatment?
Duong: Pharmacists bring valuable expertise in optimizing Ig therapy by individualizing it based off of the patient's histories, comorbidities, and tolerability. There are many different Ig products out there. As pharmacists, we are those who are educated and know the differences between these products and can help guide those decisions. For example, some products for our Ig may contain sugar, and that may not be the best product to use in the patient who has uncontrolled type 2 diabetes. That is just one way a pharmacist can help guide that discussion in terms of product selection. Close monitoring with these infusion therapies is essential. During my check-ins with patients, I will check for infusion-related reactions and assess for delayed side effects—any side effects that occur after the infusion—and during these visits, we do discuss mitigation strategies for if these side effects were to come up. This can include nonpharmacological strategies, adjusting premedications or adding new premedications prior to their infusion, and infusion rate adjustments to see if that can improve tolerability as well. Even in some patients, switching to a different Ig product can help. Some patients may have a good clinical response to one IVIG product but may not be tolerating it as well. We could switch to another product, or we can consider switching to a different mode of administration, from IVIg to SCIg, as SCIg has fewer systemic side effects and can help mitigate that for patients.
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