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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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Publicly Funded Shingles Vaccine Program Expanded

Publicly funded shingles vaccination has been available for many years for adults aged 65-70. Initially, the vaccine provided was Zostavax, which was a live vaccine given as a single dose. Protection decreased with time and by 8 years, very little protection remained. Zostavax is no longer marketed in Canada. In the last few years, the newer non-live shingles vaccine, Shingrix became publicly funded for the 65-70 age group. It is given as 2 doses, two-six months apart. We are still seeing excellent effectiveness 10 years after giving the vaccine. The likelihood of getting shingles increases with age, and 1 in 2 people will get shingles at age 80 and above. Vaccination is recommended for the public from age 50 but is not funded until age 65. For adults who are immunocompromised either by a medical condition or treatment, shingles vaccination is suggested from age 18.

Some private insurance plans pay for vaccinations, however, there are many adults who could benefit from protection who are paying out of pocket. Shingrix does not require a prescription and can be purchased at the pharmacy where a pharmacist can also provide the injection. As a catch-up for those aged 65-70 who did not have access to getting their vaccine due to COVID, the government is extending the publicly funded vaccines to those born in 1949,1950, 1951, and 1952. This means you can still get your complimentary Shingrix if you are turning 71, 72, 73, or 74 up until the end of December 2023. In 2024, the coverage will go back to just 65-70 years of age.

Click here for more information on the shingles vaccine and government coverage.

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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What’s in store for 2023…

Happy New Year to our Charlton Family! We enter 2023 with much excitement as treatments for autoimmune diseases continue to expand making our ‘tool chest” bigger. Therapies marketed for psoriasis and psoriatic arthritis are being approved for inflammatory bowel diseases, and new technologies are being implemented to offer slow subcutaneous injections as an alternative to infused medications. Newly discovered mechanisms for treating autoimmune conditions will offer new classes of medication. Advances in COVID prevention and treatment have evolved over the last year with Evusheld and Paxlovid. Pharmacists in Ontario can also prescribe Paxlovid for eligible adults either based on age (people over 60) or high level of infection risk. The RSV (respiratory syncytial virus) vaccine is expected to be approved this year for adults. This comes after the release of the newest pneumonia vaccine, Prevnar 20, in August of 2022. Each year at national and international rheumatic disease, dermatology, and gastroenterology meetings, thousands of posters are presented showing research in these fields. It is inspiring!

As Health Canada approves new therapies, we will share this information with you through our blog series. Stay tuned for the exciting year ahead.

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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Our Top Blogs of 2022

As we near the end of 2022, we thought we would share some of our most popular blog posts of the past year with you. We’ve talked about a huge number of subjects this year, but these ones were your favourites!

3. Opening of the Charlton Digestive Disease Centre

2. Health Canada Approves Three New Adalimumab Biosimilars

1. Paxlovid Information

We want to hear from you! Is there a blog topic that you haven’t seen us write about yet? Let us know what you would like to learn about in 2023 by sending us an email!

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Preventing Falls

According to Health Canada’s guidance on fall prevention, falls are the leading cause of injury among older Canadians.  In fact, 20-30% of seniors experience one or more falls each year.  As winter is upon us, so comes the ice and an increased risk of falls. However, falls don’t just occur on icy pavement; 50% of falls causing hospitalization occur at home.   

Reducing the risk of falls is important in preventing fractures.  95% of all hip fractures are caused by falls.   When a person has osteoporosis, a broken bone does not heal in the same way as a healthy bone and this puts extreme stress on the body as a whole.  For people on blood thinners, a fall can lead to bleeding risk which can be life-threatening when hitting the head. 

Many factors increase the risk of a fall: poor balance, decreased muscle and bone strength, reduced vision or hearing, and unsafe conditions in and around your home.  Exercises that promote muscle strength and balance are excellent ways to reduce falls.  Daily walks, Tai Chi, core exercises, and lifting weights are all helpful.  Eating a balanced diet that contains protein also helps build muscle and promote strength.  Vision and hearing tests are suggested to be sure you have the support needed to see and hear well.

It is also important to look at every room of your house to ensure floor surfaces are clear of clutter to avoid tripping. Bathroom supports including grab bars,  shower chairs, and anti-slip surfaces should be in place.  Good footwear, even inside the house,  provides good stability.  Mobility aids (walkers, wheelchairs, etc) can be purchased from authorized dealers where the proper assessment of your needs can be made and government financial assistance offered.  Occupational therapists can perform these assessments as well as do home visits to be sure fall risk is minimized.

In the winter ensure ice has been cleared on your walkway.  Ice grips can also be added to the bottom canes and to footwear as additional protection from falls.

For further information, click here.

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. 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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Skyrizi (risankizumab): Newest Treatment for Crohn’s Disease

On October 20, 2022, Health Canada granted approval for SKYRIZI® (risankizumab) as the latest addition for the treatment of moderate-severe Crohn’s disease. SKYRIZI® has been used for the treatment of moderate to severe psoriasis and recently gained approval for psoriatic arthritis. It is a protein-based medication known as a biologic and therefore must be given by infusion or injection to avoid stomach digestion. The approved dose for Crohn’s disease is 600 mg as an infusion at Week 0, Week 4, and Week 8, followed by 360 mg as a subcutaneous (just below the skin) injection 4 weeks later. Maintenance doses are given every 8 weeks thereafter as an injection.  

There are many effective biologic therapies approved for Crohn’s disease. Some reduce a specific inflammatory chemical called TNF (Tumor Necrosis Factor) which is made in excess in the gut (e.g., adalimumab/Humira and biosimilars, infliximab/Remicade and biosimilars, golimumab/Simponi). Another type of biologic called vedolizumab (Entyvio) prevents immune cells (T-cells) from moving into the gut lining. Ustekinumab (Stelara) is another biologic agent that is used to treat Crohn’s by reducing the excess signaling to the immune system by blocking the signaling substances interleukin-12 (IL-12) and interleukin-23 (IL23). In contrast, Risankizumab (Skyrizi) provides a much more targeted approach than ustekinumab (Stelara) by blocking only IL-23 instead of both IL-12 and IL-23.  

The great news is that our tool chest is expanding for the treatment of this autoimmune disease! This a welcome addition to treatment as we recognize November as Crohn’s and Colitis month.

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. 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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Can I have the flu shot and COVID vaccine together?

We have had many calls asking about the timing of vaccines this fall. As clinical pharmacists working at Charlton Health, we are happy to answer any questions regarding vaccines and the timing of medications. There is no need to separate the COVID-19 bivalent booster doses from other vaccines including the influenza vaccine. Many vaccines can be given on the same day. As the newest pneumonia vaccine, Prevnar 20 was released this summer, many people are also upgrading to this lifelong protection against 20 strains of bacterial pneumonia. It can also be given at the same time as other vaccines. Shingrix for shingles protection is offered in two doses, usually 2 months apart, and can also be given with other vaccines. So when getting vaccinated, consider other vaccines that you may require.

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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New Treatment Approved For Atopic Dermatitis

Atopic Dermatitis is commonly referred to as eczema. The foundation of the condition is skin barrier dysfunction, whereby allergens and infectious organisms can penetrate below the skin. This results in the release of histamine and other inflammatory chemicals causing redness of the skin and a frequent intense itch. Scratching the skin causes further irritation, making the inflammation and itch even worse. About 85% of people with atopic dermatitis experience their first flare before age 5. Approximately 25% of pediatric patients have recurrent symptoms into adulthood. 

Regular moisturizing is vital to maintain a healthy skin barrier along with avoiding triggers such as perfumes, air fresheners, candles, and smoking. Using soapless cleansers and shampoos, stress reduction, and avoiding curtains and carpets to reduce pollen, dander, and dust mites can all be beneficial. Although most people have mild to moderate symptoms that can be managed with these strategies and prescription creams, about 10% of people have moderate to severe symptoms that may require advanced therapies that reduce the immune response. Some of these advanced therapies include biologic treatments composed of protein, typically given as an injection.  However, there are some newer targeted treatments made available in tablet form. The latest addition to the list of oral targeted treatments for atopic dermatitis is called Abrocitinib, marketed as CIBINQO. It joins another medication in the same family, upadacitinib (Rinvoq) which is also approved for atopic dermatitis. Both medications are swallowed once a day and prevent immune cells from generating excess inflammation. Charlton Health is pleased to offer advanced therapies for many conditions, and we welcome this new addition to our treatment offerings.

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. 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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Are you eligible to receive Evusheld?

Health Canada has approved Evusheld as a preventative treatment for COVID-19. It is not intended to replace COVID-19 vaccinations, but rather to add another layer of protection in patients who are predicted to have a poor antibody response to the vaccine. It is a biologic therapy composed of 150mg of Tixagevimab and 150mg of Cilgavimab. These proteins are antibodies that are designed to block the entrance of the virus into human cells. The treatment is given as a set of two injections given in the buttocks. Over the last several months this preventative treatment has been made available to oncology and transplant patients. As of October 2022, Evusheld is also being made available to individuals receiving intravenous medications rituximab (commonly used in rheumatology) and ocrelizumab (widely used in the treatment of Multiple Sclerosis). A prescription is required, and injections are being offered through many clinics throughout the province and in some physician offices.

If you are receiving either of these medications, you can contact your prescriber to see if this therapy is appropriate for you. In the event that you contract COVID-19, antiviral treatment should be initiated as soon as possible to further decrease the risk of developing severe outcomes from the virus.

As a reference, we have provided a document to share some general information about this treatment made available by Ontario Health.

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. 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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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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