For our last blog, we continued a series of how specific biologic medications work.

Rituxan was the first medication presented in February 2018 and last week we shared how anti-TNF biologics work.  This was prompted by a patient asking me to express in writing what I verbally explain when someone is starting this medication.

There are many inflammatory substances produced in the human body.  In rheumatoid arthritis, two inflammatory substances have been identified that are made in excess.  One is TNF (tumour necrosis factor) and the second is interleuken-6, known as IL-6.  Whereas TNF can be made in excess in many autoimmune conditions, IL-6 is only made in excess in the joints of people with rheumatoid arthritis.  There are five treatments approved by Health Canada that remove TNF and these were featured in last week’s blog.  There are two approved biologics that remove IL-6:

• Sarilumab (Kevzara)- taken every other week by pre-filled syringe
• Tocilizumab (Actemra)- taken every other week or weekly depending on the person’s weight.  An intravenous form is also available and given monthly.

Treatments which remove IL-6 or TNF have an equal chance of putting a person with rheumatoid arthritis in low disease activity or remission.

As with all biologics used in autoimmune conditions, the risk of infection is a little greater than in the general public and therefore updating adult vaccines is suggested.  Anti-I-L-6 therapies are not given when someone is experiencing an active infection.

These treatments not used in patients who have diverticulitis.  Regular blood work is done to measure liver enzymes and a complete blood count.  Anti-IL-6 medications may increase both the “good” cholesterol HDL and the “bad” cholesterol LDL, but due to their ability to lower inflammation in blood vessels, they are considered protective against cardiovascular disease.

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.

Recently, we’ve discussed how specific biologic medications work.

Rituxan was the first medication presented and we also shared how Orencia (abatacept) works.   This was prompted by a patient asking me to express in writing what I verbally explain when someone is starting this medication.

This week we are featuring biologic therapies that reduce the inflammatory substance TNF (tumour necrosis factor).

Within our immune system are dendritic cells.  Their job is to survey the body and report any irregular cells or invaders, such as a virus or bacteria.  Unfortunately, in many autoimmune conditions (rheumatoid arthritis, ankylosing spondylitis,  psoriatic arthritis, psoriasis, Crohn’s and ulcerative colitis) , these cells generate an alert to the immune system which results in excess inflammation being made within specific tissues (joints, skin or the gut lining) where there is no infection.  In all these diseases, TNF (tumour necrosis factor) is made in large amounts leading to damage, which is irreversible.  The goal of anti-TNF biologics is to attach to TNF and remove it from the body, to prevent further damage and put the disease into a state of low disease activity if not remission.

As with all biologic medication, anti –TNF treatments are composed of protein and therefore cannot be swallowed or they would be digested in the stomach and destroyed. There are five anti-TNF therapies on the Canadian market.  Some of them are approved for multiple conditions and others for arthritic conditions only.

• Adalimumab (Humira) – given every other week by injection.
• Certolizimab (Cimzia)- given every other week or two injections monthly
• Etanercept (Enbrel –originator, Brenzys /Eralzi – Biosimilar forms of etanercept- given weekly by injection
• Golimumab (Simponi)- given monthly by injection or by infusion (rheumatoid arthritis only)
• Infliximab (Remicade –originator, Inflectra/Renflexis – Biosimilar forms) given by infusion.

As with all biologics used in autoimmune conditions, the risk of infection is a little greater than in the general public and therefore updating adult vaccines is suggested.  Anti-TNF therapies are not given when someone is experiencing an active infection.  These treatments are used in caution in patients who have a demylinating disease (ie. multiple sclerosis) or congestive heart failure.

By lowering inflammation in blood vessels, anti-TNF therapies are considered protective against cardiovascular disease.

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.

In a previous blog we spoke about what a biologic medication is, and how it is produced through the programming of live cells to produce a treatment that mimics a protein structure in a human. Biosimilars are produced after the originator biologic’s patent has expired. The living cells used to produce the biosimilar will be different than the originator biologic and therefore the final product can never be called identical, but can be considered highly similar.

Health Canada requires testing in humans to ensure the biosimilar will be as effective and safe as the original biologic. We now have two biosimilars for the medication Remicade (infliximab): Inflectra and Renflexis.. There are also two biosimilars for the medication Enbrel (etanercept):Brenzys and Erelzi. There are many more on the horizon.

The cost of biosimilars is significantly less than the originator biologic and therefore many government and private insurance plans are requesting a biosimilar be used when a person is first starting this type of treatment. Many Canadians are currently using biosimilars with great success.

As a cost saving measure, there are now insurance plans requesting patients who are on a biologic and doing well, switch to the biosimilar (if one exists for the biologic they are taking). There are many studies that have been done assessing switching from the originator biologic to a biosimilar. In most trials, patients experienced no changes. There are however situations where the switch resulted in greater improvement in a person’s disease and others where the person’s condition worsened. As we gain more experience with biosimilars, it will be important to track each manufacturer’s biosimilar to monitor any changes in effectiveness and adverse effects. There are no studies regarding switching between different biosimilars.

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.

Our pharmacist, Carolyn Whiskin recently returned from the Canadian Pharmacist’s Association meeting in Fredricton, New Brunswick where she presented on the topic of biologics and biosimilars. Biologic treatments have revolutionized the way we treat many autoimmune diseases. Human insulin is one of the first biologic treatments that was developed in the 1980’s. It is produced through the use of a bacterial cell, e-coli, which is biogenetically programmed to make insulin identical to that of a human. Since that time, many biologic treatments have been developed for many conditions; all mimicking different body produced structures based on the treatment needed. In the area of autoimmune diseases where excess inflammation is made, biologics mimic the look of antibodies. Normally, antibodies remove specific viruses or bacteria, however these biologic treatments are designed to remove specific inflammatory substances made in excess in these diseases.

When the patent expires on a biologic, this allows another pharmaceutical manufacturer to produce a product that is highly similar, but can never be considered identical as it must be produced by different cell line from the originator biologic. Health Canada has strict guidelines on how biosimilars are approved, which is much more rigorous than approval of a generic medication.

Stay tuned to a future blog to learn more about the role of biosimilars…

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.

Our Pharmacist Carolyn Whiskin recently attended the Ontario Rheumatology Association Meeting as clinical  pharmacist specializing in treatments for rheumatic diseases.  One of the presentations featured Carol Kennedy from the Health Quality Ontario  (HQO) Program. The HQO is the provincial advisor on quality health care in Ontario.

The standards being developed for many diseases to ensure quality and consistency of care across the province where very impressive.  Members of “Health Quality Ontario” look at all areas of our healthcare system with an emphasis on the patient experience. Input from caregivers and those working in the healthcare system are  vital in creating these standards. Recommendations are made on how to improve care using the best evidence.

Standards have already been developed in many areas including: depression, dementia, opioid use, hip fracture, heavy menstrual bleeding  in female adolescents and adults to name a few.  Carolyn was able to give input on the the standard for osteoarthritis, which is currently in development.

Visit the Health Quality Ontario website here to learn more, and to give input on this important process.

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.

This weekend come out  for “The Walk For Arthritis” being held in cities across Canada. Hamilton’s event is being run on June 3rd at Mc Master University.  See contact information below or visit: walkforarthritis.ca  to support this worthwhile cause.

The Walk for Arthritis is a one day community-based event that raises much needed funds for the more than 6 million Canadians affected by arthritis. By 2035, 1 in 4 Canadians will have arthritis. As the prevalence of arthritis increases, so does the demand for investment into cutting-edge research, proactive advocacy and innovative solutions that will deliver better health outcomes for people affected by arthritis.

Event Details:
Location: McMaster University (1280 Main St W, Hamilton, ON L8S 4L8)
Route Options: 1km and 5km
Registration Open: 9:00 am
Walk Start Time: 10:00 am

Contact:
Erin Lipnicky
Phone: 905.632.9390  ext. 1312
Email: hamiltonwalkforarthritis@arthritis.ca

In February 2018, we started a series on how specific biologic medications work. Rituxan was the first medication presented. This was prompted by a patient asking me to express in writing what I verbally explain when someone is starting this medication.

Today we are featuring Orencia, also known as abatacept.  This medication is approved for rheumatoid arthritis.  Within our immune system are dendritic cells.  Their job is to survey the body and report any irregular cells or invaders; such as a virus or bacteria. Unfortunately, in rheumatoid arthritis, these cells generate an alert to the immune system that results in excess inflammation being made within joints; when there is no virus or bacteria present.  The goal of Orencia is to block the signalling from the dendritic cells to prevent excess inflammation from being produced.  Unlike other biologic medications, which trap and remove specific inflammatory substances, Orencia works to prevent excess inflammation from being produced in the first place.

As with all biologic medication, Orencia is composed of protein and therefore it cannot be swallowed or it would be digested in the stomach and destroyed. There is an option of receiving a weekly injectable form of this medication or an infusion that is given monthly after the loading dose at week 0, 2, and 4.  The goal of all biologic medication for rheumatoid arthritis is to achieve a level of low disease activity or remission.

All biologics used in autoimmune conditions have a risk of infection, which is a little greater than in the general public, and therefore updating adult vaccines is suggested.  This treatment is not given when a person is experiencing an active infection.  Orencia has been used safely in many patients with pre-existing medical conditions such as kidney and liver disease.

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.

People with psoriatic arthritis now have another effective biologic treatment.  We have identified more than one inflammatory chemical which is  involved in generating excess inflammation in the joints and skin of people with psoriatic arthritis.  One of these chemicals is called IL-17 (interleukin-17).  There are two treatments which remove IL-17 which were both initially approved for psoriasis only.  Of these two treatments removing IL-17, the first one released on the Canadian market called (secukinumab) Cosentyx, has also received approval for  treating psoriatic arthritis and ankylosing spondylitis.  The second IL-17 biologic released in Canada is called (ixekizumab) Taltz.  In the last two months it has received approval for treating for psoriatic arthritis. We are thrilled to add Taltz to our list of effective treatments for this condition.  Both of these treatments are available in easy to use auto-injectors and both have a loading dose, where the medication is given weekly for the first five doses (Cosentyx ) or every other week for the first seven doses (Taltz) before starting the maintenance dose of once per month.  Our pharmacists are happy to share more information on all treatment options for psoriatic arthritis.

The Ontario Nurses’ Association is proud to celebrate and acknowledge Nursing Week 2018. Nursing Week is a time to recognize the year-round dedication and achievements of Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs), and to increase awareness of their contribution.

A BIG THANK YOU to our Charlton Nurses.  As frontline care providers, they work tirelessly to meet the needs of our patients from our infusion and injection clinics, to home infusions and with our Hepatitis clinic; their compassion extends to our patients’ families as well.

This week, take the time to thank our nurses for the effort, compassion, professionalism, and vital care they give. On behalf of all of us here at Charlton, we thank our nurses for their extraordinary care, dedicated service and contributions to quality healthcare.

FibroScan,® also called transient elastography, measures the stiffness of your liver by emitting a small pulse of energy. The more damaged or stiff the liver, the more rapidly the energy waves will pass through it. FibroScan® calculates the speed of this energy and gives your healthcare provider an immediate measure. Not only can exam results be used to monitor and assess liver damage, they can be used to anticipate complications as well.

What is a FibroScan® exam like?

You will lay on your back, with your right arm raised behind your head. Your healthcare provider will apply a water-based gel to your skin and then place the probe on the right side of your ribcage. You may feel a slight vibration on your skin, but it will be momentary and painless.

FibroScan® is ideal for patients who have steatosis and fibrosis in certain liver conditions, including:

Fatty liver/ Nonalcoholic fatty liver disease (NAFLD)

Nonalcoholic steatohepatitis (NASH)

Hepatitis B and C

FibroScan® should not be used if you are pregnant or have an implantable electronic device.

Jennifer Heipel has approximately 12 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.