Melody Chang, RPh, MBA, BCOP

Panelists discuss how increasing insurance step edit requirements for high-dose IV iron formulations have created barriers to optimal patient care, requiring providers to implement strategic prior authorization processes and develop documentation protocols to demonstrate medical necessity while advocating for appropriate patient access to these medications.

Panelists discuss how IV iron formulations requiring fewer infusion visits tend to have better adherence rates, while the ongoing nursing shortage has created additional challenges in scheduling and administering IV iron treatments, leading clinicians to favor products that can achieve iron repletion in fewer sessions.

Panelists share their final thoughts on bispecific therapies in B-cell lymphomas based on insights from the 66th American Society of Hematology (ASH) Annual Meeting and Exposition 2024.

Panelists discuss key gaps in communication between academic and community centers regarding the use of bispecifics and strategies to bridge them as well as best practices for ensuring a smooth transition of care when patients move between settings.

Panelists discuss how nonadherence to IV iron therapy can lead to persistent anemia, worsening symptoms, increased health care utilization and costs, and diminished quality of life, with patients experiencing continued fatigue, reduced work productivity, and increased risk of complications from their underlying conditions.

Panelists discuss how the lower incidence of hypophosphatemia and related complications with ferric derisomaltose and ferric isomaltoside compared with ferric carboxymaltose influences treatment selection, monitoring protocols, and preventive strategies for patients requiring intravenous iron therapy.

Panelists discuss the benefits of implementing bispecific therapy programs in the community setting as well as factors influencing the decision to administer these agents at an academic center vs a community setting.

Panelists discuss best practices for successfully implementing a bispecifics program and overcoming logistical challenges.

Panelists discuss how hypophosphatemia can cause both acute effects like muscle weakness and confusion and chronic complications such as osteomalacia and metabolic disturbances, potentially impacting patients’ mobility, energy levels, and overall quality of life if not properly monitored and managed.

Panelists discuss how black box warnings on IV iron products, particularly regarding hypersensitivity reactions, influence their risk assessment, patient selection, monitoring protocols, and facility requirements for administration, while emphasizing that modern formulations have significantly improved safety profiles compared with older products.

Panelists discuss the most common logistical challenges encountered when implementing bispecific therapies in both academic and community settings.

Panelists discuss how step-up dosing protocols reduce cytokine release syndrome (CRS) risk in patients with high-risk disease and when modifications might be necessary as well as the incorporation of infection prevention strategies, including prophylactic antimicrobials, into management plans.

Panelists discuss how modern FDA-approved intravenous iron formulations, including ferric carboxymaltose, ferumoxytol, and iron sucrose, offer improved safety profiles and more efficient iron delivery compared with older compounds, thanks to their more stable carbohydrate shells and controlled iron release mechanisms.

Panelists discuss how oral iron therapy, although convenient and cost-effective, has significant limitations, including gastrointestinal adverse effects and poor absorption, leading many patients to experience iron intolerance or inadequate response, which often necessitates switching to intravenous iron administration for more reliable and rapid repletion of iron stores.

Panelists discuss key strategies for preventing cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) in patients receiving bispecific therapies for B-cell lymphomas.

Panelists discuss how real-world data on the incidence of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) compare with clinical trial findings as well as the most critical patient-related risk factors for developing these toxicities.

Panelists discuss how monitoring patients with iron deficiency anemia requires regular follow-up appointments to track laboratory values, assess symptom improvement (particularly fatigue), and evaluate treatment response while considering the impact of comorbid conditions, with adjustments to therapy made based on both objective markers and patient-reported outcomes.

Panelists discuss how comparative data from matching-adjusted indirect comparison (MAIC) analyses guide treatment decisions between bispecific therapies and the insights from MAIC results comparing epcoritamab and glofitamab that may influence therapy selection.

Panelists discuss key factors in deciding between monotherapy and combination approaches for bispecific therapies in follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) as well as the potential for combination therapies to be more viable in certain B-cell lymphoma subtypes.

Panelists discuss how diagnosing iron deficiency anemia requires comprehensive laboratory testing of iron parameters alongside clinical assessment, emphasizing early detection to prevent complications in patients with common comorbidities like chronic kidney disease, heart failure, and inflammatory bowel disease, where coordinated treatment approaches must balance managing both IDA and the underlying condition.

Panelists discuss how the sequencing of bispecific therapies in first-line vs later-line settings should be guided by factors such as disease stage, prior treatments, and patient-specific characteristics to optimize therapeutic outcomes.

Panelists discuss how several studies evaluating bispecific therapies in earlier lines of therapy for diffuse large B-cell lymphoma and follicular lymphoma suggest that patients with high-risk or relapsed/refractory disease are most likely to benefit from these treatments.

Panelists discuss how iron deficiency anemia manifests through debilitating symptoms, including severe fatigue, weakness, shortness of breath, headaches, and difficulty concentrating, which can profoundly impact patients’ daily functioning, work performance, and overall quality of life.

Panelists discuss how emerging data on odronextamab in diffuse large B-cell lymphoma suggest its potential to play a significant role in therapy, with promising results that may position it alongside or as a superior option compared with currently approved bispecifics.

Panelists discuss how iron deficiency anemia significantly impacts patients’ quality of life through symptoms like chronic fatigue, shortness of breath, and cognitive dysfunction, while also creating substantial psychosocial burdens including depression, reduced work productivity, and social isolation, particularly affecting vulnerable populations who may face barriers to diagnosis and treatment.

Panelists discuss how exciting new data from ASH 2024 on bispecific therapies for B-cell lymphomas, including epcoritamab in diffuse large B-cell lymphoma, mosunetuzumab in follicular lymphoma, and odronextamab are shaping treatment algorithms by providing long-term follow-up data that could influence therapeutic strategies and patient management.

Panelists discuss how chronic kidney disease leads to iron deficiency anemia through a complex interplay of impaired iron absorption, increased hepcidin production driven by inflammatory cytokines, and reduced erythropoietin synthesis, resulting in both functional and absolute iron deficiency alongside diminished red blood cell production.

In 2023, the United States was in the midst of the largest drug shortage in a decade, including lifesaving platinum-based medications to treat a variety of cancers.