Recommendations for the Implementation of the Self-Administration of Alpha-1 Antitrypsin

Abstract

Administration of exogenous alpha-1 antitrypsin (AAT) is the only specific therapy for the management of pulmonary morbidity in patients with AAT deficiency. It requires weekly or biweekly intravenous infusions, which may impact patient independence and quality of life. Self-administration of AAT therapy is an alternative to reduce the burden for patients who require AAT therapy. We presented herein experts' recommendations for the implementation of a program for the self-administration of AAT. Methods: This project was conducted using a modified nominal group technique and was undertaken in two online meetings involving the participation of 25 experts: specialists in pulmonology (n=17), nurses (n=5) and hospital pharmacists (n=3). Results:The following issues were discussed, and several recommendations were agreed upon on the following topics: a) patient profile and clinical evaluation, establishing selection criteria that should include clinical as well as social criteria; b) role of health care professionals, suggested roles for specialists in pulmonology, nurses, and hospital pharmacists; c) training by the nurse, including recommendations before initiating the training and the content of the training sessions; and d) logistic issues and follow-up, adherence, and patient support. Conclusion:We expect this proposal to increase awareness of this therapeutic alternative and facilitate the implementation of selfadministration programs, thus contributing to optimizing the patient experience with AAT therapy. Further research on the outcomes of these programs, especially from the patient perspective, will also help to improve their design and implementation.

Case report: Self-administration of alpha-1 antitrypsin therapy: a report of two cases

“…For completely different reasons, in these two cases, self-administration was adapted to the patients' needs: independence for an active life in one case and fear of being infected with COVID-19 during a hospital visit in the other; both cases share the patients' need for avoiding clinic-based administration of augmentation therapy. The selection of these patients is consistent with a recent experts' recommendations for the implementation of the self-administration of augmentation therapy that establish the following objectives: to empower the patient to actively manage and control the disease, to promote family/work conciliation and patient independence, to avoid nosocomial respiratory infections in the context of the COVID-19 pandemic, and/or to reduce the costs associated with augmentation therapy (Torres-Durán et al, 2023). Both cases needed 6-7 training sessions of 45 min, which is double the 2-3 sessions on average reported in a study in the United States (Herth et al, 2021).…”