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.
Below this post, you will find all of our blogs in chronological order, with the newest blogs posted first.
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Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that can be very painful and difficult to manage. Inflammation of the sweat glands around hair follicles is where the inflammation occurs (eg, armpits, groin, and buttocks). Trapping and removing excess inflammatory substances made by immune cells in these areas is one place where biologic treatments can be very effective. Adalimumab (Humira and its many biosimilars) lowers the inflammatory substance TNF (tumor necrosis factor) and has been a very effective treatment for HS. Secukinumab (Cosentyx) lowers the inflammatory substance IL-17a (interleukin-17) and is also an approved biologic therapy for this condition.
Health Canada has now approved bimekizumab (Bimzelx) as another biologic treatment option for adults with moderate to severe HS who have not responded well to conventional systemic therapies, such as antibiotics (eg, doxycycline) or steroids (eg, prednisone). Bimzelx lowers the level of IL-17a and IL-17f.
For HS, Bimzelx is given as an injection at a dose of 320 mg every 2 weeks for the first 16 weeks, followed by every 4 weeks thereafter. This can be administered as one 320 mg injection or two 160 mg injections, using either a prefilled syringe or an autoinjector.
This new indication for Bimzelx adds to its existing approvals for use in psoriasis, psoriatic arthritis, and axial spondyloarthritis. Charlton Health is excited to offer another important option for patients living with HS.
Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more.
As the year comes to a close, we wish you a joyful holiday season filled with comfort, health, and peace. Thank you for trusting us with your care.
From all of us at Charlton Health, Happy Holidays!
Pulmonary arterial hypertension occurs when there is increased pressure in the small blood vessels that send blood to the lungs. It is characterized by symptoms such as shortness of breath, chest discomfort, or fatigue. Since these symptoms are closely related to other lung conditions, PAH can be further diagnosed using blood tests, scans, clinical tests, but the best way to confirm is by doing a heart catheterization. It is important to note that if PAH is left untreated, it can become life-threatening.
Until now, PAH has mainly been managed with medications like Opsumit or Revatio to help relax the blood vessels. These medications can help with symptoms, but many patients find that their condition may continue to progress despite being on multiple oral medications for their symptoms.
A new treatment option is now available: Winrevair (sotatercept). It is the first injectable medication for PAH. Instead of simply relaxing blood vessels, Winrevair targets the cell overgrowth that causes lung vessels to narrow in the first place. By doing this, it helps improve blood flow and reduce pressure in the lungs. For now, Winrevair is used in addition to standard PAH therapy, not in place of it.
In clinical studies, patients on Winrevair walked 40 meters farther during the six-minute walk test and had improvements across all key measures, which shows a significant benefit! Common side effects of this medication include nosebleeds, headache, diarrhea, and small visible blood vessels (telangiectasias). Increases in hemoglobin and decreased platelets can occur as well, which is why regular blood work is done.
Winrevair is a weight-based injection given every 3 weeks. The goal is for patients to self-inject, but if you need support, your Charlton Health team can help. Our pharmacists can train you for your first dose, or we can arrange ongoing injections with one of our nurses.
For more information on PAH, visit Pulmonary Hypertension Association Canada.
Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more.
Polymyalgia rheumatica (PMR) is an inflammatory condition that causes widespread joint and muscle pain along with stiffness, especially in the shoulders and hips. Symptoms often affect both sides of the body and can appear sudden or develop over several days to weeks. It mostly affects adults over age 50 and is more common in people over 65. Corticosteroids such as prednisone have been the standard treatment for PMR, but despite their use, many patients flare while tapering, relapse after discontinuation, or require long-term steroid use. Long-term exposure to corticosteroids increases the risk of weight gain, diabetes, high blood pressure, weakening of bones and fractures, cataracts, and more.
Kevzara (sarilumab) is a biologic medication that has commonly been prescribed by rheumatologists for moderate to severe rheumatoid arthritis. Recently, Kevzara has also been approved for use in adults with PMR, who have had a poor response to prednisone or for whom prednisone cannot be tapered without having a flare. Using Kevzara will allow for tapering of prednisone over a shorter period of time with a reduced chance of flares.
If you are a patient with PMR, Kevzara could be a treatment to consider with your rheumatologist. Charlton Health is pleased to support patients using biologic treatments for many immune-mediated conditions.
Parvinder Sahota is a clinical pharmacist and a graduate from the University of Toronto. He enjoys learning about the ever-evolving field of autoimmune conditions and their treatment options.
Respiratory Syncytial Virus (RSV) is a common virus that can cause serious lung infections, particularly in older adults and those with underlying health conditions. Because there is no treatment for RSV (which can cause severe coughing, phlegm, and shortness of breath for months after infection), vaccination is an important preventive measure. Vaccination can help prevent severe illness and hospitalization.
Abrysvo® (Pfizer’s RSV vaccine) was previously approved only for adults aged 60 and older and for pregnant women. Health Canada has now expanded its use to include adults aged 18–59 who are at increased risk of RSV-related lung disease. This includes individuals with chronic heart or lung disease (such as asthma or COPD), diabetes, weakened immunity, kidney or liver disease, certain neurological conditions, or class 3 obesity (BMI ≥40).
Arexvy® (GSK’s RSV vaccine) remains approved for adults 50–59 at risk and all adults 60 and older, though eligibility may expand in the future.
Both Abrysvo® and Arexvy® remain publicly funded only for those 75 years and older and those between 60-74 years old who are considered ‘high risk’ for RSV. Some of those individuals include those living in seniors’ residences and long-term care homes. However, many people will receive this vaccine through private insurance or may decide to pay out of pocket. Check with your pharmacist or primary care provider to see if you are eligible for public coverage.
With more adults now eligible, it’s a good time to ask your healthcare team whether RSV vaccination should be part of your protection plan!
Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more.
Health Canada has recently approved Rinvoq (upadacitinib) for adults living with Giant Cell Arteritis (GCA). Rinvoq is the first and only once-daily, non-steroidal pill approved to treat this condition. GCA causes inflammation in blood vessels, often leading to headaches, jaw pain, or vision problems, making quick treatment important to prevent serious complications.
Until now, treatment for GCA has relied mostly on long-term steroid (prednisone) therapy. Prednisone works effectively; however, it can cause side effects like elevated blood sugar, increased infection risk, weight gain, high blood pressure, and bone loss. Rinvoq offers a new option for GCA patients to taper off steroids faster—in about 6 months instead of a full year—while still controlling inflammation. In a major clinical trial, nearly half of patients on Rinvoq stayed in remission for a year, compared to less than one-third of those using steroids alone. Many also began to feel better as early as 3 months into treatment.
This approval represents meaningful progress for patients with GCA. It will provide an effective oral therapy that may help maintain remission, protect vision, and reduce the burden of long-term steroid use. Rinvoq is already used in Canada for other immune-mediated diseases such as rheumatoid arthritis, Crohn’s disease, and ulcerative colitis, and now offers hope for those managing this serious form of vasculitis.
Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more.
Every year on October 12, World Arthritis Day raises awareness about the millions of people living with arthritis and related joint conditions. In Canada alone, more than 6 million people are affected by some form of arthritis. The most common include osteoarthritis, caused by deterioration of cartilage, and rheumatoid arthritis, an immune-mediated condition where the body’s immune system attacks its own joints. Psoriatic arthritis and ankylosing spondylitis are also part of the arthritis family, driven by immune cells moving to joints and causing inflammation.
While arthritis cannot always be prevented, early diagnosis and treatment can significantly impact joint health and overall quality of life. Staying active, maintaining a healthy lifestyle, and avoiding smoking and excessive alcohol can all help reduce risk and ease symptoms.
But before we mark World Arthritis Day, World Mental Health Day (October 10) reminds us that mental and physical health go hand-in-hand. Chronic pain can affect mood and sleep, while stress and anxiety can worsen physical symptoms. It’s important to care for both—by staying active within your limits, reaching out for emotional support, and talking openly with your healthcare team about how arthritis affects your overall well-being.
This week is a chance to raise your voice, learn, and show support for those living with chronic conditions. Whether it’s joining an awareness event, reading resources available on Arthritis Society Canada, or simply checking in on a loved one, every action helps move toward a future where joint and mental health are equally prioritized.
Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more.
Tremfya (guselkumab) has been available for several years to treat plaque psoriasis and psoriatic arthritis. More recently, it was approved for ulcerative colitis (UC) and Crohn’s disease. This brings a new option for people living with inflammatory bowel disease (IBD). Since inflammation in the gut can be more severe and widespread than in the skin or joints, Tremfya is given at higher doses for IBD compared to psoriasis or psoriatic arthritis.
For Crohn’s disease, treatment can start with either IV infusions of 200 mg at Weeks 0, 4, and 8, OR with subcutaneous injections of 400 mg (two 200 mg injections) at Weeks 0, 4, and 8. The choice will depend on factors such as prescriber and patient preference. After this induction phase, maintenance is given as either 100 mg every 8 weeks or 200 mg every 4 weeks.
For ulcerative colitis, the induction for now is only available in the intravenous (IV) form – 200 mg at Weeks 0, 4, and 8. This will be followed by the same maintenance options as Crohn’s disease: 100 mg every 8 weeks or 200 mg every 4 weeks.
At Charlton Health, we can dispense both the IV option and the convenient new 200 mg autoinjector. For Crohn’s patients, this means induction can be done with just two 200 mg injections rather than four 100 mg pens (which was the only available option previously).
With these new approvals, Tremfya provides another flexible, effective, and self-administered option for people living with IBD.
Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more.
This week, many will return to school, and it’s no secret that the back-to-school season often sparks a rise in infections and seasonal illnesses. While it may start in classrooms, it quickly spreads beyond schools, as parents and caregivers carry viruses into workplaces and the wider community. For those on biologic medications, we want to take a moment to remind you of a few important precautions.
If you develop an active infection, such as the flu or COVID-19, it’s important to hold your biologic dose until you’re feeling better. Once recovered, you can resume your medication and adjust the schedule accordingly. For example, if you normally give your injection every other Wednesday but you’re sick on the day it’s due and don’t feel better until Sunday, you should delay the injection until Sunday. From then on, your injection schedule would shift to every other Sunday. If you receive your biologic by infusion and are sick for your scheduled infusion, please call your clinic to cancel and reschedule your appointment as soon as possible.
Tips to Reduce Infection Risk
There are proactive steps you can take to help reduce your risk of illness and avoid potential delays to your biologic therapy:
1. Stay Up to Date on Vaccines
Non-live vaccines such as the flu shot and COVID-19 boosters can be received at any time during biologic treatment; you don’t need to skip or delay your dose. If you’d like a list of recommended vaccines including protection for shingles, RSV and pneumonia , please do not hesitate to contact us and we’ll be happy to send it to you.
2. Practice Good Hand Hygiene
Wash your hands regularly with soap and water, especially after being in public spaces and before eating.
3. Maintain a Nutritious Diet
In addition to eating a variety of fruits and vegetables, consider incorporating foods with natural antiviral and antibacterial properties. Garlic, coconut oil, lemons, ginger, turmeric, and honey are great additions to support your immune health.
4. Prioritize Sleep
Even during busy times, aim for 7 to 8 hours of sleep each night. Rest is essential for reducing stress and giving your body time to repair and restore immune function.
If you’re ever unsure about whether to hold your dose or how to manage your biologic during an active infection, don’t hesitate to reach out, our pharmacy team is here to help. Wishing everyone a safe and healthy return to school!
Janine Fletcher is a 4th-year pharmacy student from the University of Waterloo and is currently completing a rotation at Charlton Health. She is passionate about improving health outcomes for patients with chronic conditions and is on track to become a licensed pharmacist this year.
Staying well hydrated is important in every season, but it becomes especially crucial during the
summer. Dehydration occurs when your body loses more fluids than it takes in. In hot weather,
we lose additional fluid through sweat as the body works to cool itself down. To stay balanced
and prevent dehydration, it’s important to drink more fluids than usual during warmer months.
While many fluids can help with hydration, Canada’s Food Guide recommends water as the
beverage of choice.1 It’s free of sugar, calories, artificial additives, and preservatives, making it
the healthiest and simplest way to stay hydrated.
It can be difficult to know exactly how much water you need, as hydration requirements vary from person to person.2 However, if you experience signs of dehydration, it’s a clear indication
that you need to increase your fluid intake. Common signs include dry lips and mouth, flushed
skin, headaches, dizziness or fainting, and dark yellow, strong-smelling urine.3 On the other
hand, pale, clear urine and feeling well are good signs that you’re properly hydrated.
Some tips to stay hydrated:
– Have a glass of water as soon as you wake up and with each meal
– Carry a water bottle with you throughout your day, especially if you are going to be
outside
– Add a slice of lemon, lime, cucumber, or other fruits to your water for a refreshing twist
This marks the final blog post in our summer series. We hope you’ve had a safe, fun, and well-
hydrated summer. See you in September!
Janine Fletcher is a 4th-year pharmacy student from the University of Waterloo and is currently completing a rotation at Charlton Health. She is passionate about improving health outcomes for patients with chronic conditions and is on track to become a licensed pharmacist this year.
