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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Now that the warmer weather is here, many of us are spending more time enjoying the outdoors. Whether you’re heading to the beach, going for a walk, or just relaxing in your backyard, it’s important to keep sun safety top of mind. Research has shown that people with immune-mediated inflammatory conditions like rheumatoid arthritis, inflammatory bowel disease, and psoriasis have a higher baseline risk of skin cancer compared to the general public.1,2 Annual skin checks with your health care provider are recommended. Additionally, applying sunscreen to all exposed skin while outdoors helps protect against skin cancer.
The Canadian Cancer Society offers the following sunscreen recommendations⁴:
For people taking medications that increase sensitivity to the sun, a sunscreen of SPF 50 or greater is often recommended. For such medications, the pharmacy will place a sun warning sticker on the medication label.
Sun safety is a small step that can make a big difference. Studies have shown that daily use of sunscreen can reduce the risk of developing squamous cell carcinoma (SCC) by about 40% and lower your melanoma risk by 50%.5 By taking a few minutes to apply (and reapply) sunscreen, you can enjoy the outdoors this summer while protecting your health. Be sure to apply the sunscreen 15 minutes before going outside to allow it to absorb in advance of sun exposure.
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.
References
Biosimilars are becoming more common in Canada, offering patients trusted alternatives to the originator biologic medication. Biosimilars are not the same as generics. Generics are exact chemical copies of brand-name drugs, like acetaminophen for Tylenol. Biosimilars are made from living cells and are highly similar, but not identical, to the original biologic. Because of this, they go through extensive testing to confirm they work just as well and are just as safe.
Two new biosimilars, Omlyclo (omalizumab), the biosimilar to Xolair, and Tyenne (tocilizumab), the biosimilar to Actemra, have now been approved in Canada.
Omlyclo is used for asthma, chronic hives, nasal polyps, and food allergies. Clinical trials showed that people who switched from Xolair to Omlyclo experienced the same level of safety and effectiveness. Interestingly, in the U.S., Omlyclo is even approved as interchangeable with Xolair, meaning a pharmacist can substitute it without a new prescription. While Canada doesn’t allow for interchangeability within biosimilars, the U.S. designation highlights how closely the two products match.
Tyenne is used for rheumatoid arthritis, giant cell arteritis, and juvenile arthritis. Just like Actemra, it’s also available in the intravenous and injectable formats.
Biosimilars like Omlyclo and Tyenne meet Health Canada standards. They offer more treatment options and improve access to drugs, without compromising quality. At Charlton Health, our pharmacists are here to support you and answer any questions you may have about switching to a biosimilar.
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.
If you have a weakened immune system due to a condition (for example, rheumatoid arthritis) or due to a treatment (for example, chemotherapy), you may be at higher risk of developing shingles (herpes zoster). Shingles can have serious complications such as long-lasting nerve pain, vision problems, increased risk of stroke and heart attack, and even hospitalization. The good news is that the shingles vaccine, Shingrix, is now officially recommended for adults aged 18 and over who are immunocompromised.
This updated guidance comes from Canada’s National Advisory Committee on Immunization (NACI), which reviewed research showing that Shingrix is both effective and safe in people with lower immunity. The vaccine can lower your risk of shingles by up to 90%, and even helps prevent post-herpetic neuralgia, a long-lasting nerve pain that can follow a shingles infection.
If you’re immunocompromised, you should receive two doses of Shingrix, ideally 2 to 6 months apart, but it can be taken as early as one month apart. This update makes it clear that preventing shingles is possible, and you don’t have to wait until you’re 50!
Public health supply of this vaccine is made available to physician offices for people aged 65 to 70. Outside of that age range, many people use a private insurance plan or pay out of pocket. Several patient support programs for advanced therapies in rheumatology, dermatology, and gastroenterology will support the cost of vaccines, such as Shingrix.
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.
If you have Crohn’s disease or ulcerative colitis (IBD), you might also have joint pain—and it may not be a coincidence. This type of joint pain could be linked to your IBD and is called enteropathic arthritis. It is more common than you may think and affects more than half of people with IBD.
Enteropathic arthritis can show up in different ways. The most common kind affects big joints like your knees, wrists, or elbows, and it often flares up when your IBD does. A less common type affects smaller joints (like the ones in your hands) and doesn’t always follow the same pattern as your gut symptoms.
It’s important to know that your joint pain could be part of your IBD, because it can change how your treatment is managed. Some IBD medications – for example, infliximab (i.e. Remicade) or adalimumab (i.e. Humira) – can also help with joint pain. But on the contrary, common arthritis medications, such as NSAIDs (ex. ibuprofen) can make IBD worse, so they would need to be avoided. In some cases, other treatments like methotrexate or azathioprine may be added to help with both joint and gut inflammation. People with both conditions often see a gastroenterologist and rheumatologist who coordinate the choice of treatments.
Besides medication, gentle activities like swimming, yoga, or biking can help keep your joints from feeling stiff and improve movement.
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.
Though HIV and autoimmune diseases both involve the immune system, they operate very differently. Autoimmune diseases occur when the immune system mistakenly attacks the body’s own healthy cells, often requiring immunosuppressant treatments to control inflammation and prevent further harm. On the other hand, HIV is a virus that specifically targets and destroys immune cells, weakening the body’s defense against infections and leading to increased susceptibility to various illnesses. Understanding this distinction is vital for understanding the nature of these conditions and the different treatment methods available.
Autoimmune diseases are typically managed with medications that suppress the immune system’s overactivity. In contrast, HIV treatment focuses on antiretroviral therapy (ART) to lower the viral load and improve immune function, preventing the progression to acquired immunodeficiency syndrome (AIDS). Although individuals with HIV may have autoimmune-like symptoms, HIV is not classified as an autoimmune disease. However, the long-lasting immune activation and damage caused by HIV can increase the risk of developing certain autoimmune conditions. Regular monitoring and individualized treatment plans are key for effectively managing both HIV and autoimmune diseases.
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 day, Charlton pharmacists counsel patients on advanced therapies for many immune-mediated conditions. Some of this discussion focuses on how the medication works to treat a particular condition. We discuss the risks and benefits of treating vs. not treating a condition. It is important to note that if the benefits of any treatment do not outweigh the risks, the medication is not approved by Health Canada. Patients may respond differently because of their individual characteristics, medical histories, other medications, and their level of disease. However, an expert health professional who understands the disease and medications can effectively put all the risks and benefits into context, allowing patients to make an informed decision about their care.
It is common for some patients to rely on information from various internet sites, including “chat groups” where certain adverse effects of a medication are highlighted by others who have used the treatment. This can often lead people to avoid treatments that could be beneficial for them. It is important to note that the thousands of people who are doing well may not be sharing their experiences on these sites. This results in a skewed sense of the actual risk.
Keep in mind that not all internet sites are misleading. In fact, there are many sites that are validated by medical experts and are excellent sources of general information.
For example, The Arthritis Society, The American College of Rheumatology, and the Crohn’s and Colitis Foundation of Canada are great websites run by medical experts. See a full list of our recommended resources here.
Remember, we are here to answer your questions. If you read something that concerns you, reach out to fully understand the context of this information and how it may or may not impact you.
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.
Ustekinumab was first launched in Canada in 2008 under the name Stelara by the manufacturer Janssen. It is a protein-based treatment, which we refer to as a biologic. It treats many immune-mediated conditions such as psoriasis, psoriatic arthritis, Crohn’s, and Ulcerative Colitis. Depending on the condition being treated, standard dosing is based on injections given every 8-12 weeks. When the patent for the original Stelara expired, it allowed other pharmaceutical companies to produce ustekinumab after studies were conducted to show it was as effective and safe as the originator product. Health Canada has now approved a few biosimilars of ustekinumab.
Until now, ustekinumab has only been available as a standard pre-filled syringe from either the original manufacturer or from other companies making a biosimilar. Patients self-inject using a traditional syringe or get assistance from a medical professional.
Wezlana is an ustekinumab biosimilar made by the manufacturer Amgen, and they have just launched the first ustekinumab as an autoinjector. This device is referred to as the Confipen. Most biologic medication manufacturers offer a pen option. Patients appreciate that it can make injections at home easier and reduces anxiety for those with a fear of seeing a needle. We are excited that a pen option now exists for ustekinumab. For patients currently using the syringe format of ustekinumab who would benefit from a pen, you can reach out to your specialist to see if a change in prescription is appropriate. There is no cost difference between the pen and syringe, and private insurance plans that cover the syringe have now added the pen as a benefit. Government-based plans such as the seniors plan (ODB) and Trillium are likely to cover the Confipen soon. We will post an update when the pen becomes a benefit for these plans.
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.
Charlton Health is pleased to support Colorectal Cancer Awareness Month. Each Friday, staff who are donating are entitled to wear blue jeans to work. Colorectal cancer is the 4th most diagnosed cancer in Canada, and there is a 90% cure rate when found early.
As outlined on the Colorectal Cancer Canada website, the fecal immunochemical test (FIT) is a screening test for colorectal cancer. It detects small amounts of blood in your stool that are not visible to the naked eye. You can do it at home in a few minutes. It is: easy, painless, private, and free. Individuals between the ages of 50 and 74 without a personal or family history of colorectal cancer are suggested for testing. If you do not have a family doctor to access the FIT test kit, you can call 1-866-828-9213 to access a home test kit. Those with a higher risk for colorectal cancer may be referred for a colonoscopy instead of a FIT for their screening. The main message is to get tested, as early detection is the key!
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.
Pharmacy Appreciation Month is celebrated each March as a time to highlight the growing role pharmacy professionals play in our healthcare system and thank them for their extraordinary efforts. Pharmacists are the most accessible health professional and serve a vital role as part of the healthcare team. At Charlton Health, we are fortunate to have a team of dedicated, knowledgeable, and caring professionals who have great passion for their profession. It gives us great pleasure to educate patients on their specialty medications and the conditions they treat. Some of our pharmacists are involved in teaching at the University of Toronto, writing journal articles, serving on committees of the Ontario College of Pharmacists, and lecturing to health professionals across Canada.
The Canadian Pharmacists Association has launched a contest called #MyFavePharm. They are asking the public to share with them why they love their pharmacy team. Those who complete and submit nomination forms before 11:59pm ET on March 21 will be entered into a draw for an opportunity to win a tablet for both them and their favourite pharmacy team member! Open to residents of Canada. Enter here: #MyFavePharm contest
Pharmacists work in hospitals, long-term care facilities, community pharmacies, specialty pharmacies, and the pharmaceutical industry providing medical information and conducting research. They are educators in universities and colleges, and often conduct presentations for the public. Pharmacists usually complete an undergraduate degree in science followed by four years at a faculty of pharmacy along with an internship. Graduates obtain a PharmD designation which is a clinical doctorate in pharmacy. At Charlton Health we are proud to support the education of future pharmacists by offering internship placements to students completing their final year of study.
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.
As we end the month of February, it is a good time to reflect on the importance of the heart. I recently asked a group of women what the word ‘heart’ meant to them. I received many answers, such as being at the core of a thought or issue, being kind to ourselves and others, and heart health. Working with patients with immune-mediated conditions, we think about heart health regularly since increased inflammation in the body can lead to increased inflammation in blood vessels that supply the heart muscle. People with inflammatory arthritis (such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) and those with psoriasis have greater cardiovascular risk when their immune-mediated condition is not well controlled, and inflammation is high. With that in mind, being on treatments that keep your condition in a low disease state is very important. Ensuring blood pressure and cholesterol are well controlled is also important in reducing this risk. Of course, healthy eating and exercising for a minimum of 150 minutes a week is a guideline for all of us – whether we live with immune-mediated conditions or not. Similarly, lowering stress is a part of reducing risk to the heart. Remember, being kind to yourself and doing what you can to support your well-being should be a priority, as we all need to take time to do the things that provide the greatest fulfillment.
Be kind to yourself and be kind to your heart!
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.
