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Wise Words Wednesday Blog

This series features answers to some of the most frequently asked questions our pharmacists receive, as well as information on all the latest research surrounding biologics and the conditions they treat.

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Infliximab Now Available As An Injection for Crohn’s and Ulcerative Colitis Patients

Infliximab is a protein-based medication referred to as a biologic that treats many immune-mediated conditions.  The original manufacturer of this medication is Janssen, and they named it Remicade. In the last several years other manufacturers have produced infliximab as biosimilars. Some of these include Avsola, Inflectra, and Renflexis. The medication was given intravenously in an infusion clinic.  

The exciting news is that the manufacturer Celltrion now has a form of infliximab that can be injected instead of requiring you to attend an infusion clinic.  This injection format has been available for a few years for patients with rheumatoid arthritis but in February there was a new approval for Crohn’s and ulcerative colitis.

For inflammatory bowel conditions, the first three doses will be given at weeks 0, 2, and 6 as infusions.  This is followed by an injection every 2 weeks, starting from week 10.

Patients with rheumatoid arthritis can follow the same schedule as above or have the option to start directly with the injections weekly for the first 5 doses followed by a maintenance dose every 2 weeks.  

At Charlton, we work with referring physicians, patients, and drug company support programs to help secure the best coverage for these specialty medications.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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A New Treatment For Ulcerative Colitis

On October 3rd, 2023, Health Canada approved Eli Lilly’s newest biologic for the treatment of moderate to severe active ulcerative colitis (UC) called Omvoh. With a limited number of therapies available for UC in Canada, the introduction of a new advanced treatment is another step towards giving Canadians living with UC additional personalized treatment options.

Omvoh reduces excess signaling to the immune system and therefore prevents the production of inflammation in the gut lining. The actual signaling chemical it lowers is called interleukin-23 (IL-23).  Another medication that works in a similar way is Skyrizi (risankizumab), however, it is only approved for Crohn’s disease, psoriasis, and psoriatic arthritis. Stelara (ustekinumab) is another approved treatment option in UC and Crohn’s disease which lowers both signaling chemicals; IL-12 and IL-23.

The starting dose of Omvoh for UC is 300mg given as an infusion every 4 weeks for 3 doses. The infusions last roughly 30 minutes each. This is followed by 2 injections (=200mg) every 4 weeks. The injection is available as an autoinjector or pre-filled syringe.

Working with your gastroenterologist, Charlton Health is excited to provide our patients with this newly available treatment. 

Parvinder Sahota is a clinical pharmacist and a recent graduate from the University of Toronto. He enjoys learning about the ever-evolving field of autoimmune conditions and their treatment options.  

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Show Love to your Heart

As February is heart month, today is an excellent occasion to really show why we love our hearts and how we can reduce our risk of cardiovascular disease.  Many studies have shown that patients who have autoimmune conditions are at higher risk of developing heart-related problems such as heart attacks and strokes.  This is in addition to the risks from other conditions and lifestyles like smoking, diabetes, high cholesterol, and high blood pressure. There are several changes we can make to our lifestyles to reduce heart disease risk and ensure our heart is always loved.

The first step is eating healthy, and a well-balanced diet will also help maintain a healthy weight. Canada’s food guide is a great place to start learning about portions, healthy recipes, and other tips. Click on the following link to access Canada’s food guide: Canada’s Food Guide.

The next step is to address movement and sleep.  The Canadian Society for Exercise Physiology (CSEP) has created a diagram for each age group that shows the recommended time of physical activity and sleep required to keep our heart healthy, along with limiting inactive/sedentary time.

Ex. Adults aged 18-64:

·         Physical Activity – 150 minutes per week of moderate to vigorous aerobic exercise which can be spread out throughout the week.

·         Sleep – 7 to 9 hours of quality sleep with consistent wake-up/bedtime.

·         Sedentary lifestyle – less than 3 hours of recreational screen time and minimizing long periods of sitting.  

Click on the following link to access their resources: 24-Hour Movement Guidelines – Canadian 24-Hour Movement Guidelines (csepguidelines.ca)

Our heart never takes a break for us. It pumps for 24 hours and 7 days a week. Let’s do our part to show our hearts some love by making healthy lifestyle choices.

Parvinder is a clinical pharmacist and a recent graduate from the University of Toronto. He enjoys learning about the ever-evolving field of autoimmune conditions and their treatment options.  

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Charlton Infusion Clinic Expansion

To better serve our Hamilton and area patients, we have expanded and moved our Stoney Creek Clinic for infusions to 211 Pritchard Road unit # 4.  With this expansion, we have additional space to offer our Hamilton patients while maintaining our downtown clinic option at 25 Charlton Ave East! We are pleased that patients will have a greater choice in the option to attend downtown or the new site.  The 211 Pritchard Rd clinic location has complimentary parking and is located on the main floor for easy access. 

All patients impacted by this clinic expansion will receive a phone call in advance of their infusion, to confirm their appointment location.

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Do you use the government’s Trillium program in addition to your drug plan?

We are very fortunate in the province of Ontario to have many options for supporting the cost of prescription medications.  At Charlton Health we work with specialty medications that have a high cost.  These medications are paid for through patient’s private insurance plans, government-based plans, and drug company support programs. In some cases, patients use a combination of all three types of coverage.  We specialize in coordinating this process.

For patients who have a private plan that has a limit to the amount of drug costs it will cover within a year, it may be necessary to use the government-based Trillium Drug Program to help pay the balance of prescription costs. In this situation, the receipt for the portion of the prescription payment not funded by the private plan will now be submitted to the Trillium website rather than being mailed in. This must be submitted by the patient or a member of their household.

For people using Trillium in addition to their private plan, you will be hearing from our team to provide more details on the new process and payment details.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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Happy New Year from Charlton Health!

The team at Charlton Health is celebrating the New Year at our new location, 211 Pritchard Rd. Unit 4 in Hamilton.  Our team is very excited with our new expanded space and patients who live locally have been very pleased with the easy building access with no stairs or elevators and complimentary parking.  We wish everyone much health, happiness, and hope for the year ahead. 

At this time of year, we often reflect on the blog posts of the previous year and thank you for your many kind comments in finding our posts helpful.  If you have a question that you feel would provide helpful information for others, don’t hesitate to reply to this blog with your topic suggestions.  We look forward to continuing to provide timely updates in the year ahead.


Respectfully,
The Team at Charlton Health

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We’re Moving!

Charlton Health Pharmacy is excited to announce our move to a new expanded facility on the East Hamilton Mountain, as of December 18th. This location has lots of free parking! The pharmacy is on the main floor of the building.

Our new address will be:

211 Pritchard Rd. Unit 4
Hamilton, ON
L8J 0G5

Due to the new address, please let us know if you wish to change your delivery status from a pick-up to delivery or from delivery to pick-up.

For any changes contact us at 905-526-7002 Ext. 2.

Please note: The Charlton Centre Infusion Clinic remains at 25 Charlton Ave East on the fourth floor.

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Health Canada Approves Ustekinumab (Stelara) Biosimilar

Health Canada has approved Jamteki as the first biosimilar in Canada of ustekinumab for the treatment of psoriasis and psoriatic arthritis.  We expect that it will eventually be approved for Crohn’s Disease and Ulcerative Colitis as the originator ustekinumab (Stelara) is currently.  Approval for an ustekinumab biosimilar from Amgen is also expected soon. Likely additional approvals for other manufacturers will follow.

The date for the product availability of Jamteki has not yet been announced. We are also awaiting how coverage for ustekinumab will be impacted by this approval, by both government and private insurance plans.

Stay tuned…

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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Ontario Provides Coverage for the Osteoporosis Medication Evenity (romosozumab)

Treating osteoporosis is vital to preventing fractures. Once a person has experienced a fracture of a weakened bone, especially after the age of 65, their risk of having another fracture in the next 1-2 years is greatly increased. Menopausal women who fall in this very high fracture risk category will now have access to the advanced therapy, Evenity. This funding is limited to those who have not had a previous prescription medication for osteoporosis as using a medication that builds new bone as a first treatment is much more successful at preventing fractures.  

Evenity is typically given as two injections once a month for a year. After the year, the person would then take a different medication to prevent bone-eating, to maintain the growth they received on Evenity.   

The medication will still require an application to the government to verify that the person meets the criteria for having a high risk of fracture.

We are very excited about this new coverage for such an effective osteoporosis treatment.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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Answering Your Vaccine Questions (RSV and more…)

In August, we wrote about Health Canada’s approval of a long-awaited vaccine for RSV (respiratory syncytial virus), known as Arexvy, which is for those aged 60 and older. RSV largely impacts those who are young (especially those under age 2) as well as those over age 60. In older adults who become hospitalized with this lower respiratory tract infection, the risk of death is 1 in 9. Although age alone increases risk due to aging lungs and the immune system, those with underlying medical conditions are at an even greater risk. 

Now that we have Arexvy available, we are getting many questions about timing with other vaccines that adults are updating this fall. RSV is a seasonal virus that begins its greatest spread in the fall and winter months, just like influenza. With the new COVID booster now available, this is also the time for many to be receiving it as it has been 6 months since many received their previous dose.  For those who have not yet had pneumonia or shingles vaccines, these are also ones to consider. Here are answers to some of the questions we have been receiving. Note that this is general advice and is not to replace guidance from your own healthcare team.

Is Arexvy being provided through the government?

Arexvy will be provided to all long-term care residents at no charge this fall.  All other adults aged 60 and over will either need to pay out-of-pocket or use their coverage through a private plan.  A prescription from your family’s physician’s office will be needed. It will primarily be dispensed by community pharmacies, where patients may also receive the injection if requested on the prescription by the prescriber.

How long does the protection from Arexvy last?

Arexvy provides protection for at least 2 seasons. Further ongoing research will inform us if the protection lasts even longer.

Can I get more than one vaccine at a time?  I am due for the influenza vaccine, COVID booster, and RSV this fall.

Any non-live vaccines can be given together according to the National Advisory Committee on Immunization (NACI). All the vaccines mentioned above are non-live. COVID boosters have commonly been given at the same time as the influenza vaccine in the last two seasons. When giving two vaccines, they would be given in separate arms. Although not commonly done, if multiple vaccines are needed at the same time, it is possible to receive more than one vaccine in the same arm,  if they are at least 1 inch apart. We have seen this done when a person has limited opportunity to be vaccinated or may be leaving on vacation and needs multiple vaccines before travel. Studies reported no concerns when Arexvy was given at the same time as the annual flu shot. Another consideration is that some vaccines may cause redness and soreness at the injection site along with some general aches and pains or even a low-grade fever. For this reason, some people prefer to separate vaccines to not compound this impact on the same day. Others want to assess how a new vaccine makes them feel and for that reason want to separate it from others. What is important to realize, is that by separating all vaccines you may not make the time to return and get them all done. This is why doing two at a time has become a common practice. Regardless of what preference you and your healthcare provider choose, it is safe and effective to receive vaccines together. Arexvy has the same adjuvant (vaccine booster) as Shingrix, but only half the amount, so you may have a similar reaction to it.

Do I need to delay my treatments for my autoimmune condition, such as biologics, when getting a non-live vaccine for RSV, pneumonia, shingles, COVID, or flu?

It is not necessary to hold or delay most biologic/advanced treatments. We would suggest not administering a new vaccine within a few days of a biologic injection or infusion, so if you feel unwell you can determine which was causing your symptoms. The exception to this is methotrexate, which can be held for two doses after receiving the flu shot for best effectiveness. This should only be done in a person whose condition is stable and not flaring. We only have data to support this suggestion for the flu shot, although some clinicians may advise holding methotrexate for other vaccines as well. The other exception is for people receiving a specific type of biologic that suppresses B-Cells called rituximab or ocrelizumab. When receiving these treatments, the timing for the best vaccine benefit is 2 weeks before an infusion or 5 months after the previous infusion.  If a person is on prednisone, vaccines will be most effective when the dose has been below 20mg per day for at least 2 weeks.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

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