Dr. Katerina Pavenski
Head of the Division of Transfusion Medicine at St. Michael’s Hospital
John Haslam
General Manager, argenx Canada
With Canada struggling to meet immunoglobulin self-sufficiency targets, coordinated policies that expand plasma collection while supporting appropriate non-plasma treatment options are critical.
Immunoglobulin is an essential component of the immune system that can be derived from donated human plasma and used to treat a range of immune, blood, and neurological conditions. It’s delivered to patients as either intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG).
Demand for immunoglobulin is growing rapidly in Canada. According to Dr. Graham Sher, CEO of Canadian Blood Services, demand has increased by 38 per cent over the past five years.
Several factors are driving demand. Dr. Katerina Pavenski, Head of the Division of Transfusion Medicine at St. Michael’s Hospital in Toronto, says they include population growth, an aging population, a growing list of indications, and better access to appropriate care.
Canada doesn’t manufacture IVIG or collect enough plasma to meet demand. “We heavily rely on IVIG manufactured elsewhere from plasma collected from paid American donors,” says Dr. Pavenski.
Managing a precious resource
Canadian Blood Services and Héma-Québec are working to increase supply, but achieving self-sufficiency targets has been challenging. According to Canadian Blood Services, domestic immunoglobulin sufficiency increased to 34 per cent this year, up from 27 per cent a year ago. While that represents progress, Canada is still heavily reliant on the U.S. for plasma-derived products.
For some patients, immunoglobulin is irreplaceable.
“In general, patients with immune deficiency do not have other alternatives, while other patients with autoimmune conditions, for example, may be treated with other agents,” says Dr. Pavenski. “Having said that, some patients who receive IVIG for various autoimmune indications have tried alternatives and did not respond to them, so they too are now dependent on IVIG.”
As a result, Canada needs to manage immunoglobulin demand carefully while expanding supply.
Making room for alternative therapies
Some autoimmune neurological conditions traditionally treated with immunoglobulin, including chronic inflammatory demyelinating polyneuropathy (CIDP) and myasthenia gravis, now have innovative non-plasma treatment options for certain eligible patients. Treating one CIDP patient with IVIG can require over 300 plasma donations per year. Having an alternative could reduce immunoglobulin demand, preserving it for patients without other options.
“We need to look for alternatives. We need to be judicious with our use of blood products and ensure that they’re there for those that need them the most,” says John Haslam, General Manager of global immunology company argenx Canada.
Access is a barrier. While immunoglobulin is provided at no direct cost to patients through Canada’s health care system, alternative therapies can be expensive and may not be funded, Dr. Pavenski notes. When asked what policymakers should prioritize to strengthen Canada’s immunoglobulin supply, her answer was direct: “Fund alternatives.”
Breaking down barriers to better coordination
This funding barrier reflects a broader issue: blood products and pharmaceutical therapies are funded and managed through separate systems. There’s no established budget or policy framework to incorporate non-plasma therapies alongside blood products. Because the two systems are distinct, it can be challenging for decision-makers to take a wider view when assessing costs, access, and supply considerations.
“If a drug can save taxpayer money in health care, then it should be seriously considered, even if it means that it’s coming from a different budget,” says Haslam.
In the case of Canada’s immunoglobulin supply and the patients who rely on it, a more coordinated approach would mean incorporating non-plasma alternatives for eligible patients into immunoglobulin planning, treatment algorithms, and utilization criteria.
Haslam says that argenx works with payers, patient groups, health care practitioners, and policymakers to build awareness and develop evidence about the clinical and health-system value of its therapies.
Alongside increasing domestic plasma collection, incorporating appropriate non-plasma alternatives for eligible patients can contribute to a more resilient, sustainable blood system in Canada.
This article was made possible with support from argenx.