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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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New Advanced Therapy Approved for Ankylosing Spondylitis

At Charlton Health, a center specializing in advanced treatments including biologic therapies, we are often excited when additional treatment options are made available for patients with autoimmune diseases. Recently, Rinvoq© (upadacitinib), an oral treatment option for Rheumatoid Arthritis, Psoriatic Arthritis and Atopic Dermatitis was also approved to help treat Ankylosing Spondylitis.

Rinvoq© (upadacitinib) is in a class of medications called JAK inhibitors.  Other medications in this class include Xeljanz© (tofacitinib) and Olumiant© (baricitinib).  In Canada, Rinvoq© is the first of this class, to be used for Ankylosing Spondylitis (AS). This is amazing news for our patients living with AS, because their advanced treatment options consisted of only injections or infusions. If appropriate, for those patients who may not be comfortable self-injecting at home or be able to periodically attend a clinic for an infusion, Rinvoq© (Upadacitinib) may be a convenient option to be taken as one tablet by mouth every day.  

 Interestingly, another medication, Sotyktu© (deucravacitinib), within a similar class of medications as Rinvoq©, was recently approved for treating moderate to severe plaque psoriasis in the United States. Currently, it is under review for approval by Health Canada and if approved, patients with psoriasis may also benefit in the future with the additional availability of an oral treatment option. 

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. Since January 2021, 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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Updated COVID-19 Vaccine Information

With updated COVID-19 vaccines becoming available as booster doses to offer better protection against variants of the SARS-COV-2 virus, it is important to be aware of who is eligible to receive them. 

At Charlton Health, we continue to serve immunocompromised patients who are being treated for a variety of autoimmune diseases. We recognize and acknowledge the value that these new vaccines bring to better protect our patients. Currently, in Canada, one new bivalent vaccine (manufactured by Moderna) can be given as a booster dose for individuals who have completed the primary series of COVID-19 vaccines. 

As of September 12, 2022, Ontario’s Ministry of Health has recognized the following high-risk individuals to be eligible for the new COVID-19 bivalent Moderna booster vaccine dose (regardless of how many booster doses the individual had received in the past):

  1. Residents of long-term care homes, retirement homes, Elder Care Lodges and individuals living in other congregate settings that provide assisted-living and health services
  2. Individuals aged 70 years and older
  3. Individuals who are 12 years and older with moderately to severely immunocompromising conditions
    • For those between the age of 12-17 years of age with moderately to severely immunocompromising conditions, a booster dose of the bivalent Moderna COVID-19 vaccine may be offered off-label based on clinical discretion
  4. Individuals that are 18 years and older who identify as First Nations, Inuit, or Metis and their non-Indigenous household members aged 18 years and older  
  5. Pregnant individuals that are 18 years and older
  6. Healthcare workers that are 18 years and older 

As of September 26, 2022, all individuals 18 years and older will be eligible to receive a fall COVID-19 bivalent (Moderna) booster dose (regardless of how many booster doses the individual had received in the past).

Table 2 from the COVID-19 Vaccine Guidance published by Ontario’s Ministry of Health provides the recommended timing interval between the primary series and booster doses of COVID-19 vaccines. It is important to highlight that for those individuals who are moderately and severely immunocompromised individuals, a primary series consists of 3 vaccine doses. The guidance also highlights the timing of the vaccine doses relative to previous infections, which would be important information for individuals who may have recently contracted COVID-19 and want added protection from the booster doses. 

For more information on these updates, you can review the guidance here.

**Please note that this is only the latest information as of September 9, 2022. As more information on the growing topic becomes available, the guidance will likely also be updated. 

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. Since January 2021, 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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Opening of the Charlton Digestive Disease Centre

We are pleased to share the upcoming opening of the Charlton Digestive Disease Centre at 25 Charlton Ave. East in Hamilton. This will be an outpatient Gastroenterology clinic with a primary focus on exemplary patient experience. We have had the pleasure of working with the gastroenterologists that will be servicing the clinic. They are offering a comprehensive service of endoscopy and colonoscopy procedures, as well consultation and follow-up.

The clinic is committed to lowering the wait times that patients are experiencing with digestive health issues. If you are in need of such services, our referral form can be used by your family physician.

Any questions about the Centre and its services can be directed to Jennifer Heipel at 905-526-7002 ext 1104 or visit our website.

Jennifer Heipel has approximately 15 years of experience working as a hepatology nurse/clinical research coordinator for several gastroenterologists, hepatologists, infectious diseases and addiction specialists. She is trained in the treatment of Hepatitis B and C therapies as well as general hepatology and pre/post liver transplant follow up. Jennifer serves as Charlton Health’s full-time Hepatology Nurse and manages the Hepatology Program. She has worked and continues to work with Dr. Puglia at McMaster University and other area Gastroenterologists to develop a comprehensive, in-house Hepatology program and Hepatitis C program here at Charlton Health.

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Psoriasis Action Month

August is Psoriasis Action Month and at Charlton, we are happy to provide advanced therapies to many people living with psoriasis and to acknowledge Psoriasis Action Month. It is important that people without psoriasis are educated to reduce misconceptions they may have about the condition.  

Psoriasis is an autoimmune disease that showcases its symptoms on the skin and nails. There are different types of psoriasis that are diagnosed based on the type of rash and areas the rash presents.  

Below are common misconceptions about psoriasis, clarified. 

Misconception The Truth 
“Psoriasis is contagious” Psoriasis is not contagious. It is an autoimmune disease that is caused due to unknown reasons. Some factors that might be linked to causing psoriasis include stress, smoking, specific genes, family history.  
“Psoriasis comes from poor hygiene” It is an autoimmune disease. This means the immune system is working in excess. This excess inflammation from the immune system presents on the skin. It has nothing to do with a person’s hygiene routine.   
“Psoriasis is only a skin condition” Although the main symptom of psoriasis is skin presentation, inflammation is still happening in other parts of the body. Inflammation can be in the cardiovascular system and put patients at increased risk of heart disease. Some people with psoriasis also have psoriatic arthritis, which is inflammation and stiffness in the joints. For better overall health, it is very important to get the disease under control and reduce inflammation on the skin as well as all other affected parts of the body.  

For more information about lifestyle and healthy skincare with psoriasis, please see our previous blog “Management of Psoriasis” posted on February 24, 2022. At the end of that blog are great links to resources to further educate yourself about psoriasis.  

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World Hepatitis Day

World Hepatitis Day is July 28 and we want to help raise awareness for these diseases. They are a group of infectious diseases that affect the liver, known as hepatitis A, B, C, D and E.  

At Charlton Health we have a great team that specializes in hepatology and offer fibroscans for their patients. Fibroscan machines are special ultrasound machines that are used to scan your liver. The machine is looking for liver scarring or otherwise known as fibrosis. This information, along with blood tests, will give the doctor more information about a person’s liver disease.  

The different types of hepatitis have different ways of transmission. They also vary as some are short-term infections while others are long-term infections. The best way to protect your health is to prevent infection, the best ways to prevent the different hepatitis infections are listed in the table below. 

Hepatitis A Get vaccinated  
Hepatitis B Get vaccinated  
Hepatitis C There is no vaccination for hepatitis C, so the best way to prevent infection is to avoid spreading it. Spread is caused by being in contact with infected blood and ways to prevent the spread include: Wearing gloves and personal protective equipment when you may be in contact with blood  Not sharing needles  Ensuring tattoo parlors, nail salons, spas, and more are practicing safe cleaning procedures Not sharing toothbrushes Getting tested if you may have had exposure to hepatitis C is important because there are now very effective treatments that are taken for 8-12 weeks that can lead to cure. If you get treated sooner, you are much more likely to prevent permanent liver damage. Charlton Health is pleased to provide Hepatitis C treatments.  
Hepatitis D Although there is no vaccination for hepatitis D, only people with hepatitis B can get hepatitis D. Therefore, the best way to prevent hepatitis D is to get your hepatitis B vaccines.   
Hepatitis E There is no vaccination for hepatitis E. Hepatitis E is spread by someone unknowingly ingesting the virus, which is found in the stool of those infected. Most commonly, hepatitis E is contracted through contaminated drinking water. However, in developed countries, this is uncommon. There have been reports of people contracting hepatitis E through raw pork, boar, and shellfish, hence ensuring meats are properly cooked is one way to prevent hepatitis E. However, the best way to prevent hepatitis E is through proper water sanitation. For countries and areas without proper water sanitation, it is important to: Not drink unpurified water Be aware of dirty water warnings and boil water advisories  

For further information about the details of hepatitis and prevention, visit the Center of Disease Control and Prevention (CDC) Website.

Marija Ilic is a Pharmacy Student from the University of Waterloo currently doing a rotation at Charlton Health as part of her final year of studies. Through Marija’s education, she has gained experience in both hospital and community pharmacy settings and hopes to find a specialized pharmacy role when she graduates. 

Jennifer Heipel has approximately 15 years of experience working as a hepatology nurse/clinical research coordinator for several gastroenterologists, hepatologists, infectious diseases and addiction specialists. She is trained in the treatment of Hepatitis B and C therapies as well as general hepatology and pre/post liver transplant follow up. Jennifer serves as Charlton Health’s full-time Hepatology Nurse and manages the Hepatology Program. She has worked and continues to work with Dr. Puglia at McMaster University and other area Gastroenterologists to develop a comprehensive, in-house Hepatology program and Hepatitis C program here at Charlton Health.

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Prevnar 20 Approved by Health Canada

Vaccination to prevent bacterial pneumonia is suggested for all patients with either a medical condition or immunosuppressive treatment that increases their infection risk. Before starting on advanced therapies such as biologics, we suggest adults update their vaccines, which includes pneumonia protection. Prevnar 13 is a vaccine protecting against the main 13 types of bacterial pneumonia and one dose lasts for a person’s whole life.

Health Canada has just approved Prevnar 20, which is already available in the United States. This will provide lifelong protection against an additional 7 types of pneumonia and will likely replace Prevnar 13. It should be available for purchase by the end of July. It is our hope that it will be publicly funded for compromised adults over 50 as Prevnar 13 is currently.

If you have received Prevnar 13 in the past, you may consider upgrading to this enhanced protection when it is made available to you as long as it has been at least 6 months from the previous Prevnar 13 dose.

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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Evusheld: who is eligible?

We have received questions regarding Evusheld as a pre-exposure preventative treatment for COVID-19. Evusheld is given as two intramuscular injections. This is only being supplied and administered at select clinic sites such as cancer and transplant centers due to the limited criteria for its use.  

Evusheld is currently available in Ontario only to select immunocompromised patients, including:

• Solid organ transplant recipients
• Stem cell transplant recipients
• CAR-T cell therapy recipients
• Other hematologic cancer patients undergoing treatment

Currently,  this means that patients receiving advanced therapies for autoimmune conditions are not included in the eligible list.

Please see the Government of Ontario document here for more information.

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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Bimzelx© (Bimekizumab): The new biologic treatment for psoriasis

Charlton Health is excited to announce that we have started dispensing a very promising new treatment for psoriasis! This new treatment is called Bimzelx© and it is an interleukin -17A/17F inhibitor. Interleukin-17s are proteins that play a large role in the inflammation we see in psoriasis. The idea of interleukin-17 inhibitors is to normalize the levels of these proteins to reduce inflammation in the skin, and potentially in other parts of the body. 

Charlton Health was privileged to be a part of the first Bimzelx© injection in Canada. Our team, the dermatologist, and the patient were all very excited to be a part of this moment. 

There are other interleukin-17 inhibitors on the market but this one differs in the way that specifically targets interleukin-17A and interleukin-17F. Other interleukin (IL) 17 inhibitors target IL-17A only or target a wide array of IL-17 subtypes. Bimzelx© is now another biologic in our tool kit that we can utilize for people with psoriasis. If you have been on an IL-17 inhibitor in the past that did not provide adequate relief, Bimzelx© may be an option for you, after your doctor has assessed your medical history to ensure it is appropriate for you. 

This medication is not typically used in those who have Inflammatory Bowel Diseases (IBD) such as Crohn’s disease or Ulcerative colitis. This is because IL-17 is protective of the gut. So, for those with psoriasis and an IBD, Bimzelx© may not be the best choice for you. However, there are many other effective biologics for both psoriasis and IBD that your physician can prescribe for you. 

Below is a table of the different IL-17 inhibitors on the market in Canada and some details about them.

Name Specific IL-17 targetCitrate-freeLatex-freeTypical maintenance dose for psoriasis
Taltz© (Ixekizumab)IL-17ANoAfter loading doses:  1 injection every 4 weeks
Cosentx© (Secukinumab)IL-17ANo, needle shield contains latexAfter loading doses:  2 injections every month
Siliq© (Brodalumab)Many IL-17 subtypesAfter loading doses:  1 injection every 2 weeks
Bimzelx © (Bimekizumab)IL-17A / IL-17FAfter loading doses:  2 injections every 8 weeks

For details about how citrate affects injections, please see our previous blog, “Health Canada Approves Three New Adalimumab Biosimilars.”

Marija Ilic is a Pharmacy Student from the University of Waterloo currently doing a rotation at Charlton Health as part of her final year of studies. Through Marija’s education, she has gained experience in both hospital and community pharmacy settings and hopes to find a specialized pharmacy role when she graduates. 

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World IBD Day

Inflammatory bowel disease (IBD) describes both Crohn’s disease and ulcerative colitis. Both are chronic inflammatory diseases of the gut. People who have these diseases have symptoms that include but are not limited to, diarrhea, bleeding from the rectum, pain, and tiredness. Many patients find it difficult to leave the house because they always need access to restrooms due to the unpredictability of their disease. The point of treating IBD is to reduce symptoms in order to allow patients to resume their lives without interruption by their disease. 

World IBD Day takes place on May 19 of every year. Each year there are different events to raise awareness for these diseases. This year’s slogan is “IBD has no age” which emphasizes that elderly people still suffer from IBD. The World IBD Day website includes details about events in Brazil, France, Greece, India, Ireland, and New Zealand. Click here if you are in these places or if family members are there that wish to participate.

If you are in Canada and want to get involved in raising awareness and funding for IBD, you can participate in the Gutsy Walk, which is Canada’s largest fundraiser for IBD research and patient programs! 

If you wish to participate in the walk, the event takes place on June 5, 2022. The typical participant walks 5km, but anyone can do any distance they are comfortable with. You can sign up for different regions around Canada and there is even an “Ontario Virtual Walk” option for those who may not be able to come to the walk event areas. If you are unable to participate, you can consider sponsoring a team or individual who is! For more information on the walk, please visit the Gutsy Walk website.

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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Shingrix Awareness

Many health professionals will be selecting a week in May to promote the prevention of shingles through a Shingrix Awareness Week. Shingrix is a vaccine for the prevention of shingles (Herpes Zoster). It is given as a series of 2 doses, 2-6 months apart. The vaccine is now available without prescription and can be administered by your community pharmacist. It is available at no charge through Public Health supply to family physicians for adults aged 65-70, with a catch up this year to age 72, until December 2022. Many people beyond this age range will benefit from Shingrix and will choose to pay for the vaccine out-of-pocket or may have private insurance to cover the cost.

Shingles (Herpes Zoster) is a serious disease that commonly results in a very painful, blistering rash that occurs in one part of the body and can last for weeks. The pain can be severe, disabling, and interfere with your day-to-day activities9 in 10 Canadian adults carry the virus that causes shingles. Shingles that affect the eye (Herpes Zoster Ophthalmicus) can lead to blindness and must be treated immediately. The risk of shingles increases with age and is also increased in people with autoimmune conditions. Vaccination is our best protection, as anti-viral treatments can still leave people with symptoms, including postherpetic neuralgia (nerve pain) lasting weeks-months.

Although the recommendation for vaccination against shingles generally begins at age 50, it is now approved by Health Canada for adults 18 years old and older that have a deficient or suppressed immune system caused by known disease or therapy. As Shingrix is a non-live vaccine, it can be administered to people on advanced therapies for autoimmune conditions. The prior vaccine, Zostavax, is no longer available and its effectiveness is greatly diminished by 5 years. As a result, many adults have upgraded their protection with Shingrix. It is common for people to experience pain at the site of injection along with fatigue, aches, pains, and/or a low-grade fever for a day or two after the injection. Consult with your health care provider about vaccination against shingles.

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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