Welcome to our Blog

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.

Please note: Did you previously sign up for our #WiseWordsWendesday blog? We are re-launching our mailing list and require that everyone register again online. Forgot to sign up in the first place? Now’s your chance:

Subscribe to Wise Words Wednesday blog posts:


You can also find the blog each week on Facebook:

 

Posted in The Charlton Center | Leave a comment

COVID-19 Vaccination Phase 2 Includes Compromised Patients

In writing this blog, we are all aware that the vaccine distribution continues to be updated.  Phase 2 of vaccine distribution is to include patients who have compromising conditions or treatments that suppress the immune system,  regardless of the person’s age.  The intention is for this to begin in April and in some health units, this has already happened.  This may be an opportunity for you to be vaccinated before your age group is eligible.  The question is, what information will be required when booking in order to receive a vaccine under this ‘at risk’ category.  Many patients have been asking for a note from their specialist at their most recent visit confirming to confirm their condition and that they are a person of increased risk.  I recently heard from an individual whom public health had reached out to directly,  based on a list public health received from a local family physician listing their “at-risk” patients.   Each public health unit may be implementing Phase 2 differently. What we do know is that when being vaccinated you will be asked if you are immunocompromised and you must be able to confirm that you have had a conversation with a health professional in your care about any alterations in your medications that may be needed when receiving the COVID-19 vaccine. Ensure you are prepared to answer such questions to avoid being turned away for vaccine administration.

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.

Posted in The Charlton Center | Leave a comment

First Canadian dose of Biosimilar Adalimumab (Amgevita) administered at Charlton Health!

Charlton Health is proud to announce that the first dose in Canada of the biosimilar adalimumab, known as Amgevita (produced by Amgen), was injected at Charlton Health on February 22, 2021.

Five biosimilars of adalimumab were released onto the Canadian market in February.  In alphabetical order they are: Amgevita (Amgen), Hadlima (Merck), Hyrimoz (Sandoz), Hulio (Viatris), Idacio (Fresenius Kabi), and there are still more to come.   Humira (Abbvie) is the name of the originator adalimumab, and has had the biggest distribution of any biologic in the world. 

Biosimilars are very different from generic medications.  When a traditional synthetically made medication loses its patent, another manufacturer is able to copy the chemical structure to make a generic product.  Studies are done in a lab setting to ensure the product has the same chemical properties and dissolves in the same manner as the original product in order to be approved by Health Canada.   When a biologic medication loses its patent, the process for a second manufacturer to be approved by Heath Canada is quite different.  Biologics are not synthetically produced  chemical structures; they are made by programming living cells to produce a protein.  Even batch to batch, the protein structure can have slight differences. Therefore any manufacturer wanting to replicate a biologic, must develop their own cell line to produce a protein that is as similar as possible to the original product. This biosimilar, must be studied in patients in the same way the original product was researched.  The biosimilar must show the same level of safety and efficacy to the originator to be approved. 

Biosimilars offer support programs just as the originator biologic, to ensure patients are not limited to medication access  due to the cost of the medication.  Many biosimilars are produced by innovative companies who have produced originator biologics as well; in fact Amgen, who produced the biosimilar recently injected in our clinic, also produces the originator biologic for etanercept, known as Enbrel.  There has been extensive use of biosimilars in Europe.  As an example, Amgen’s biosimilar (Amgevita) has been in Europe for over 2 ½ years.  Each biosimilar will have its own patented autoinjector device.  As devices can each have their own nuances, it is important to have training before starting.  Some of the adalimumab biosimilars also have citrate-free formulations, such as the Amgen product. This can make a difference on the comfort of the injection.

There have  been several studies based on people switching from an originator product to a biosimilar showing excellent results.  It is due to this, that last year, the province of British Columbia has mandated patients on existing biologics for which there is a Health Canada approved biosimilar, make a switch.  This has  provided significant cost savings.  We anticipate this will eventually happen in Ontario.  When this is announced, a new prescription must be written by your specialist as this cannot be automatically substituted when a medication is refilled.  There will also be time given for such a transition to allow time for a medical visit.  We will keep you informed as details are released.

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.

Posted in The Charlton Center | Leave a comment

American College of Rheumatology Announces COVID-19 Clinical Guidance Summary

The American College of Rheumatology (ACR) is a prominent organization that provides expert guidance on the diagnosis and treatment of rheumatic conditions.  Their annual meeting has over 15,000 clinicians from around the world in attendance. This week they held a town hall virtual meeting to discuss their recommendations regarding COVID-19 vaccination and how it should be managed in patients who have rheumatic diseases. 

As stated in previous blog posts, the main message is that although patients who have autoimmune diseases and are on medications that may suppress the immune system, and as such, may have somewhat less of a response to the COVID-19 vaccines or even have a short-term flare of their inflammatory condition, getting the vaccine is highly suggested and is of less risk to patients than not being vaccinated. 

Their summary document can be found here.

In Table 3 of this document, there are suggestions as to which treatments could be held for a short period of time after the vaccine to help increase the vaccine benefit. Holding any dose of medication when getting a vaccine is only suggested for patients who are stable and not flaring. 

Here are some of the highlights of this guidance:

  • Methotrexate – consider holding one dose the week after each of the COVID-19 vaccines.
  • JAK inhibitors includes: Xeljanz (tofacitinib), Olumiant (Baricitinib) and Rinvoq (upadacitinib)- hold tablets for 1 week after each vaccine dose. 
  • Abatacept (Orencia) is given by weekly injection or an infusion.  If you receive the injection, hold the dose the week before and the week after the first dose of COVID vaccine but not for the second vaccine dose.  For those on IV Orencia, when your next dose is due at 4 weeks, receive the first COVID vaccine, wait 1 week and then resume treatment (no holding of dose for the second vaccine).
  • Rituximab (Rituxan, Ruxience, Riximyo, Truxima) can significantly blunt vaccine benefit in general.  Ideally wait until 4 weeks before your next rituximab dose to get your first vaccine and then wait 2-4 weeks after the second vaccine before resuming rituximab treatment.
  • NO holding of any doses is required for the majority of treatments, including: sulfasalazine, leflunomide, hydroxychloroquine, prednisone under 20mg/day, azathioprine, IVIG, mycophenolate, belimumab, cyclophosphamide tablets and the following biologic groups of medications: (anti-TNF, anti-IL-6R, anti- IL-12/23, anti-IL-23, anti-IL-1) do not require any doses to be held at the time of receiving the COVID vaccines

As always, these suggestions are based on expert opinion and do not replace the individual advice of your specialist.

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.

Posted in The Charlton Center | Leave a comment

COVID-19 Patient Decision Aid from the Canadian Rheumatology Association and CAPA (Canadian Arthritis Patience Alliance)

Since our last blog providing guidance for the COVID-19 vaccine, we have had many calls asking if patients on disease modifying treatments, such as biologic therapies, methotrexate, leflunomide etc. should hold their dose after getting the COVID-19 vaccine for a short period of time while the body produces antibodies to the vaccine.  We do not yet have the research to let us know if this would make a difference, however it is in the process of being studied. Experts from the American College of Rheumatology are developing a guidance statement in this regard based on expert opinion.  We are hoping to see this in the next 2 weeks and will share it with you.  In the meantime, when you next have an appointment with your specialist, it is a discussion worth having.  We do not want a person to flare by delaying a dose and we also want the most benefit possible from this vaccine.

In the meantime, the Canadian Rheumatology Association along with the Canadian Arthritis Patience Alliance has developed a patient decision tool for the COVID-19 vaccine.  Click here to find this document, which could be helpful for all patients with autoimmune conditions.

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.

Posted in The Charlton Center | Leave a comment

COVID-19 Vaccine Guidance for Patients with Autoimmune Diseases

We have received many questions regarding the use of COVID-19 vaccines in patients with autoimmune diseases on a wide range of advanced therapies such as biologics. The first thing to be aware of, is that the studies done for these vaccines did not include patients with autoimmune diseases or those on treatments that may suppress the immune system.  Current advice about being vaccinated, is based on expert opinion knowing this is a non-live vaccine. The general opinion of specialists in the field is that the benefit of getting a COVID-19 vaccine far outweighs the risk. 

What you should know:

  • The COVID-19 vaccines currently available are non-live. They cannot cause COVID-19 when given to any patient.
  • The effectiveness of any vaccine given to people who have an autoimmune condition may be less effective than the public. This does not prevent you from receiving the vaccine as having a lesser effect is much better than no effect at all.
  • Most treatments for autoimmune conditions do not blunt the benefit of vaccines.  However, we do know that methotrexate can reduce the effectiveness of the standard dose influenza vaccine.  We do not know how methotrexate may reduce the effectiveness of the COVID-19 vaccines.  Some healthcare providers may suggest holding 2 doses of methotrexate after receiving this vaccine in patients who are not having a flare of their inflammatory disease.
  • We know that the infused medication rituximab can significantly blunt vaccine benefit.  The suggestion would be to wait until 5 – 5.5 months after your last dose of rituximab and receive your COVID-19 vaccine.  Then receive the second dose of the COVID-19 vaccine (in the case of the Pfizer vaccine this is 3 weeks later).  Then wait an additional 2 weeks, at which time you can resume rituximab treatment.  
  • Prednisone can blunt the benefit of vaccines when used in doses of 20mg per day or higher for more than 14 days.  If you are weaning off prednisone, waiting until your dose is less than 20mg/day would be advised for greater benefit.
  • The COVID-19 vaccines by Pfizer and Moderna are called mRNA vaccines.  When mRNA-based treatments have been given in the past, there was a potential for an inflammatory response.  These vaccines have made modifications to prevent this, but you should know that a short-term flare of your condition could happen.  This means that if possible, it would be best to be vaccinated when you are in good control.
  • Other vaccines such as Shingrix for Herpes Zoster (shingles) protection, were released onto the Canadian market with no studies in this population.  As this vaccine was non-live and had great benefit, we widely gave it to patients knowing that it may be less effective in this group of people and that there could be a short-term flare of their inflammatory condition.  As time passed,  we collected data on this group of patients and found that they had a 90% benefit vs over 97% in the general public. This is still a fabulous response. We also learned that about 5% of people had a flare of their inflammatory condition for 1-2 weeks. 
  • We have learned that anyone receiving this vaccine can experience about 24-48 hours of certain symptoms which include: fatigue, headache, sore arm, low-grade fever, and general achiness. 
  • A few people receiving the vaccine who had a background of anaphylactic reactions to foods such as shellfish, had an anaphylactic reaction to the COVID-19 vaccine.  This does not prevent people with food allergies receiving the vaccine but does suggest that anyone who carries an EpiPen and has high sensitives to allergens should have an EpiPen on hand for the vaccine administration.
  • Anyone with an allergy to polyethylene glycol should not receive the Pfizer or Moderna vaccines.
  • The COVID-19 vaccines have not been studied when given at the same time as other vaccines.  It is suggested to wait 28 days after the final COVID-19 vaccine injection before giving any other vaccines. (live or non-live)  If you have recently received another vaccine, wait at least 2 weeks before getting the COVID-19 vaccine.

The Canadian Rheumatology Association and Canadian Association of Gastroenterology  have recently published their guidelines regarding patients with autoimmune diseases, both in support of vaccination.  They can be found on these links: 

CRA_Position_Statement_on_COVID_19_Vaccination_Dec2020.pdf (albertarheumatology.com)

CAG-COVID-19-Vaccines-in-IBD-Patients.pdf (cag-acg.org)

As part of these statements,  they refer to the National Advisory Committee on Immunization (NACI) which has also stated that the COVID-19 vaccine may be offered to these individuals if a risk assessment deems that the benefits outweigh the potential risks.  They suggest that obtaining informed consent from a patient,  includes discussion about the absence of evidence of the use of this vaccine in these populations,  and that there is a potential for lower vaccine response in those immunosuppressed. It is important to note that depending on the public health unit in your community, you may be asked to sign a consent to receive this vaccine or indicate you have had a discussion with your physician.  The pre-vaccination questionnaire that you will be given by the healthcare provider giving the vaccine, identifies immunosuppressive agents and/or autoimmune disease as factors that require consent.  

Please note the general guidance provided by this statement does not replace individual advice given to you by your specialist and healthcare team. 

Posted in The Charlton Center | Leave a comment

Charlton Health Launches Educational Video Series: Inflammatory Arthritis & Its Treatments

Charlton Health would like to wish everyone all the best of health in 2021.  We are pleased to share the following series of educational videos which we have just launched for the New Year. At a time when virtual education has become a necessity, this became an important project for us. Back in May, our pharmacist, Carolyn Whiskin had been asked to fly to Thunder Bay to present an educational program for patients. Of course, this was not possible during a pandemic and this is what sparked the production of the series.  We appreciate the Thunder Bay Rheumatology Program’s initiative and encouragement in developing this program. The series covers different aspects of both understanding types of inflammatory arthritis as well as the various treatments available.  All modules were written and presented by our clinical pharmacist Carolyn Whiskin.  We suggest you watch these in order of the modules, from 1-5.  The modules vary in length with some being close to 30 minutes, so you may want to watch these over a couple of sessions and can of course replay them at your convenience.  It is also a great series to share with family members wanting to better understand your condition.  Keep in mind that this information is only intended to supplement the advice and care you receive from your rheumatologist and healthcare team.  Simply click on the module and you will be taken directly to the video. We hope you enjoy the series. 

Module 1: What is an Autoimmune Disease?

Module 2: Differentiating Types of Inflammatory Arthritis

Module 3: Holistic and Conventional Treatments

Module 4: Advanced Therapies 

Module 5: Vaccination

Posted in The Charlton Center | Leave a comment

The Power of Human Connection

A couple of years ago, we brought you a blog post called “The Health Benefits of Singing,” where we discussed how singing and other types of social activities can help with loneliness, stress, and depression. Of course, this holiday season, things are different – we certainly can’t sing together, nor can we be connected in so many of the ways that we are used to doing. We know that for so many, this lack of human connection, especially for those living on their own or in long term care, can have negative impacts on our health, such as a failure to thrive and mental health struggles.

Connecting with others is such a beautiful thing – it gives us a sense of belonging and of purpose – it builds community, and there is no question that all of these things can positively impact our mental health (and in turn, our physical health too!) We’ve come up with such innovative ways of connecting with one another throughout the pandemic – primarily we’ve seen a huge rise in video chats on Zoom or Skype, which is such a wonderful way of keeping in touch with others. With that said, we’ve also heard about ‘Zoom fatigue’ and know that through a screen, while helpful, isn’t always the best way of connecting to one another. 

So what do we do? How do we find human connection when we’re confined to our own households? This holiday season, we encourage you to make human connections in any way you can (providing it’s COVID-friendly). Some ideas we would love to share is by connecting with people outside, while masked and 6 feet apart; or visiting with someone from below while they’re on a balcony; or even by just saying hello to people at the grocery store. While limits on travelling may make it difficult to physically be with our loved ones, many of us still have neighbours we can have a safe, distanced conversation with. We encourage you to make that small effort to connect, even if it’s not with your family or close friends. Get outside and say hello – you might make someone’s day. 

This year has been a challenging one for all of us, and on behalf of all of us at Charlton Health, we would like to wish you the best during this trying time. We hope you have a very Happy Holiday season and a Happy New Year. 

Posted in The Charlton Center | Leave a comment

Looking for help to better manage your Arthritis… online?

The Arthritis Society provides care through the Arthritis Rehabilitation and Education Program (AREP) to Ontario residents with a valid health card. The Arthritis Society offers one-on-one consultations, as well as group education classes led by physiotherapists, occupational therapists or social workers.

Throughout the pandemic, the Arthritis society has done a great job of transition educational arthritis groups to virtual classes. All first visits are virtual utilizing secure telephone, email, and video conferencing.  

Education classes:

  • Stay Active – Managing Osteoarthritis Pain of the Hips and Knees
  • Osteoarthritis of the Hand
  • Osteoarthritis of the Neck and Back
  • Taking Charge of Your Rheumatoid Arthritis
  • Taking Charge of Your Fibromyalgia
  • Moving Forward With Your Feet –Workshop for Managing Your Foot Arthritis
  • An Introduction to Mindfulness Meditation
  • How to Get Better Sleep with Arthritis

For more information or to book a free appointment:

www.arthritis.ca/arep

Or call

1 800 321 1433 extension 3307

Online Resources https://arthritis.ca/support-education/resources

Posted in The Charlton Center | Leave a comment

New Treatment Approved For Psoriatic Arthritis

We are pleased to share that a new biologic treatment has been approved for the treatment of psoriatic arthritis. People who have this condition can suffer from inflammation in joints of  the hands and feet as well as larger joints such as the elbows, shoulders, hips, knees and lower back.  There is also inflammation in the tendons and ligaments that attach to these joints.  Some people also suffer with a significant amount of psoriasis where others may only have a family history of psoriasis or have limited areas on the scalp and nails. The ideal treatment will reduce inflammation in all areas to reduce pain, stiffness and areas of skin involvement.

Tremfya (guselkumab) is a large protein based treatment known as a biologic. It binds to a substance called Interleukin-23 (IL-23) to prevent excess signalling to the immune system. This results in a reduction of inflammation in all areas affected by psoriatic arthritis. It is given by injection by either a pre-filled syringe or a patient-controlled autoinjector called a One-Press. After the initial injection, a second dose is given 4 weeks later and then every 8 weeks as a maintenance dose. Tremfya was initially approved for psoriasis, but it is very exciting to see the proven benefits it has on the joints as well!

Important Update to our Blog…

We have very much enjoyed bringing you this weekly blog for the past few years. As of this month, we will be publishing blogs on a bi-weekly basis. However, if there is critical information that needs to be shared, we will post more often. We also bring you content over on our Facebook and Twitter pages, so you can always tune in there if you miss having us in your inbox as frequently!

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.

Posted in The Charlton Center | Leave a comment

Influenza Vaccine Distribution

We have received many calls with concern that their community pharmacy has already run out of the influenza vaccine.  I want to reassure you that although  there was a preliminary distribution of influenza vaccine around October 7-9th from public health, the actual launch date of full distribution to pharmacies is not until October 26th.  Pharmacies will be able to order from this date onward through their standard wholesaler under the direction of public health.  Both the standard dose and high dose vaccines will be available.  The high dose has four times the amount of inactivated influenza vaccine and has shown to illicit a greater immune response (more antibodies) against the flu for people who age 65 or older.  This does not mean that the standard dose will not work for a person over 65 but if you can access the high dose and you are age 65, it is suggested .  In provinces other than Ontario, the high dose is only being distributed to long term care homes.  We are fortunate in Ontario to have extra doses that are being distributed to family physicians and pharmacies.  The best protection however is for everyone around you, including yourself, to be vaccinated as this is what reduces spread the most. 

For those who are taking advanced therapies for their autoimmune disease, such as biologic treatments, it is safe to get either influenza vaccine as they are both inactivated.  There is no need to hold or delay a dose of your biologic to receive any non-live vaccine. If there is a perfect time to get your influenza vaccine when the effectiveness could be a littler greater, it would be 2 weeks before your next biologic dose when the level of drug is lowering. The vaccine takes 2 weeks to process. For people doing a weekly or every other week dose, take the vaccine half way between your doses.

The National Advisory Committee on Immunization (NACI) is suggesting when booking an appointment for the influenza vaccine, that you consider what other vaccines you are in need of.  This could include the pneumonia vaccines (Prevnar 13 first followed by Pneumovax 8 weeks later), the shingles vaccine (Shingrix given as 2 doses, 2-6 months apart) and others including the tetanus shot given every 10 years.  Multiple vaccines can be given at the same time.

Important Update to our Blog…

We have very much enjoyed bringing you this weekly blog for the past few years. As of this month, we will be publishing blogs on a bi-weekly basis. However, if there is critical information that needs to be shared, we will post more often. We also bring you content over on our Facebook and Twitter pages, so you can always tune in there if you miss having us in your inbox as frequently!

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.

Posted in The Charlton Center | Leave a comment