As a pharmacy specializing in the treatment of autoimmune diseases, we are privileged to speak to many patients who have found life-changing benefits from the use of advanced therapies.  Hidradenitis Suppurativa is one such condition where biologic therapies such as Adalimumab (originator drug Humira) have had a significant impact.  The sad thing is that many people with this condition are not diagnosed until they have had symptoms for over 8 years.  Early treatment is important. 

This chronic inflammatory skin disease causes lesions to develop in areas of the body that contain a high density of apocrine sweat glands. Common areas where HS develops include the armpits, underneath the breasts, inner thighs, groin, and buttocks.  The lesions can be misdiagnosed as boils.  The condition usually starts at puberty when hormonal level change and apocrine sweat glands develop.  The tissue is painful and left untreated can lead to scaring and many negative health impacts.  According to the HS Foundation,  the exact cause of HS is not currently known. Still, research so far suggests that a combination of factors of genes, defects in the structure of hair follicles and sweat glands, immune system activation, and hormones may all play a role in the development of HS.

We also recommend you have a look at the HS Foundations Guidebook for patients living with HS as it is an excellent resource that was last updated in 2022.

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 inspired by our patients living with lupus and we are privileged to provide advanced therapies that control this condition. We are pleased to share information about the WALK for Lupus.

WALK for Lupus Ontario registration is open and now finally in-person! Join thousands of participants through various WALKS across Ontario. 

The next 5 WALKS take place in:

• Richmond Hill – June 24 
• Barrie – July 7
• Hamilton/Halton – July 8
• Toronto – July 15
• Windsor – July 29

To participate in one of your local walks, visit WALK for Lupus Ontario. Registration/donation information can be found here.

The WALK for Lupus is Lupus Ontario’s largest provincial fundraising and awareness event. Over the years, the WALK for Lupus has raised over $1 million to fund the Lupus Ontario Geoff Carr Research Fellowship, support and education programs for lupus patients and their families, and advocacy projects aimed at improving programs and services for lupus patients. Lupus is a complex autoimmune disease that can impact virtually any bodily organ – skin, kidneys, brain, heart, eyes, and others – with profound life-altering and life-limiting consequences.

5 million people globally have some form of lupus, yet little is known about the disease as each patient presents with a differing array of symptoms. Hence, there is a consistently high demand for funding directed towards pioneering research, proactive advocacy, and inventive approaches that can enhance the health outcomes of individuals impacted by lupus.

Maher Jibrini is a Student Pharmacist from the University of Waterloo currently doing a rotation at Charlton Health as part of his final year of studies. Maher holds a strong passion for interprofessional collaboration at all levels of healthcare and looks forward to applying his knowledge across various professions in the healthcare & pharmaceutical industry.

The ‘nocebo effect’ is an interesting concept where negative expectations and beliefs about treatment or medicine can actually have a negative impact. This is opposite to the placebo effect, where positive expectations can result in positive outcomes. It shows how our thoughts and beliefs can affect how we feel, physically and emotionally. It’s important to be aware of our negative expectations and try to focus on positive thoughts to support our well-being. It is important to keep in mind that there are many factors that influence treatment success and this is only one of them. 

One such example of the nocebo effect was seen when studying patients who were switched from an originator molecule, such as Humira, to a biosimilar, as previously discussed on our blog. Patients who had not received the education needed to understand the effectiveness and safety of the biosimilar and alleviate any negative perceptions about the switch experienced adverse effects not seen in the group that had been fully educated. Sometimes misinformation regarding a treatment from various sources (e.g. social media), can lead to negative opinions about the treatment.

When starting a new medication or treatment, it’s important to remain aware of the nocebo effect and seek reliable sources for your information. 

To combat a potential nocebo effect, you can:

1. Stay positive
   • Maintain a positive mindset and focus on the potential benefits of your treatment. Believe in your ability to heal and stay hopeful.
2. Communicate openly
3. Talk to your healthcare provider about any concerns or fears you may have. Ask questions and seek clarification about the treatment plan, potential side effects, and realistic expectations.
4. Trust your healthcare provider
5. Build a strong relationship with your healthcare provider. Believe in their expertise and guidance.
6. Seek reliable information
7. Be cautious of unreliable sources of information that may exaggerate the negative aspects of treatment. Consult reputable sources and ask your healthcare provider for reliable information to understand your treatment better.
8. Stay engaged in your treatment

Maher Jibrini is a Student Pharmacist from the University of Waterloo currently doing a rotation at Charlton Health as part of his final year of studies. Maher holds a strong passion for interprofessional collaboration at all levels of healthcare and looks forward to applying his knowledge across various professions in the healthcare & pharmaceutical industry.

Charlton Health is pleased to launch a video explaining biosimilars.  We have received many questions about switching from an originator biologic to a biosimilar and this video will help support these questions.

We would love your feedback on this video and the tool we shared on our last blog.  Charlton Health takes great pride in providing educational resources to support patients and we appreciate our readers’ ongoing support of the content we provide.

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.

We are very excited to announce that the Canadian Spondylitis Association has added a great tool for patients to their website. This tool was developed by our own clinical pharmacist, Carolyn Whiskin.  The tool was designed to assist patients with rheumatic autoimmune diseases and better understand the risks of being in a state of active disease vs. receiving advanced therapies that can result in low disease activity or remission. It is important to understand that all treatments approved by Health Canada must demonstrate that the health benefits outweigh any risks. Even with that knowledge, patients need confidence that a treatment makes sense for them, and this tool will help in that process. 

Click here to use the Arthritis Treatment Risks tool.

We would love to hear your feedback and hope this is a beneficial resource for 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.

Many of the advanced therapies for autoimmune diseases are protein-based medications we refer to as biologics. To avoid stomach digestion, which would render at this medication ineffective, they are given by subcutaneous injection (just under the skin) or infusion. Many of the injections are available as an autoinjector or a prefilled syringe. The syringe requires a person to push the needle through the skin and depress the plunger themselves. Some of these medications require two separate injections for one dose. 

Risankizumab (Skyrizi) is a biologic treatment for moderate to severe plaque psoriasis and psoriatic arthritis. It was initially available as a 75 mg prefilled syringe and each dose required two syringes to be given. Recently, a new formulation was developed whereby the full dose of 150 mg is now contained in one prefilled syringe or an autoinjector. For patients who may not have the dexterity to use the prefilled syringe or simply may not feel comfortable using it, the autoinjector now provides an amazing alternative to enable them to successfully self-inject their medication. For both these conditions, Skyrizi is administered at week 0, week 4, and then every 12 weeks as a maintenance dose. This is a great example of how manufacturers continue to enhance these medications to make them easier for patients to administer.  

Risankizumab has also been recently approved for Crohn’s disease, but in a different format than the dosing used for psoriasis and psoriatic arthritis. When treating Crohn’s Disease, the initial doses are given by infusion in a clinic. Maintenance doses are higher than that used for psoriasis or psoriatic arthritis (600mg) requiring a different type of automated device referred to as an on-body injection. This dispenses the medication through a subcutaneous needle over five minutes while the device has adhered to the skin.

As pharmacists at Charlton Health, it is exciting for us to see this innovation and the ability to grow our resources to support patient care.

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.

March is the month we celebrate the pharmacy profession, and the role pharmacists play in patient care.  As pharmacists at Charlton Health, working with our patients and health professional colleagues across Ontario is a privilege.  We appreciate the trust you place in us as a member of your healthcare team.  We take great pride in the information we provide on a daily basis helping patients navigate and understand their specialty treatments.

Pharmacy teams have been an immense force supporting Canadians through the many challenges we’ve faced. From caring for our communities through the pandemic, helping patients navigate care amidst the current healthcare crisis, managing ongoing drug shortages, and everything in between, the contributions of Canada’s pharmacy professionals have been remarkable!

Over the past few years, pharmacy professionals have grown their roles as immunizers, prescribers, and the first point of contact to the healthcare system for patients across the country. With a healthcare system under strain, pharmacy teams are more essential than ever.

This March, join us in celebrating Pharmacy Appreciation 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.

At Charlton Health we specialize in providing biologic medications for many autoimmune conditions. 

Some of these medications have been on the Canadian market for several years and their patent to be the only company who can make the medicine has ended.

This allows other manufacturers to make their own version of the biologic medication. A new supplier of a biologic that has lost its patent, is called a biosimilar. 

The reason for the name “biosimilar” is because a biologic is produced by programming a living cell to make specific protein-based medication. The specific type of cell used will be different depending on the manufacturer, so their medication must be called “similar” rather than identical. Even batch to batch, the original producer of a biologic can have slight differences. This is why Health Canada requests studies be done with all biosimilars to ensure they are as effective and safe as the original biologic. Studies have also shown that safety and efficacy remain the same when a patient makes this switch.   

Due to the cost savings, many patients around the world have switched from an originator biologic to a biosimilar with great success. In Canada, most provinces have also switched patients to a biosimilar for the purpose of cost savings that would not impact patient outcomes. 

This is referred to as a non-medical switch. 

Ontario recently announced that the process of switching existing patients to a biosimilar will begin March 31^st and this transition period will go until the end of 2023. 

Some of the treatments for autoimmune diseases that are affected by this switch include infliximab (Remicade^©), rituximab (Rituxan^©), adalimumab (Humira^©) and etanercept (Enbrel^©).  

At Charlton Health we have dispensed ALL the biosimilars available for each of these treatments over the last several years. They are all very familiar to us and your specialist.

We will work with your specialist to provide any biosimilar needed. 

Our pharmacists will help you be educated on any change!

Charlton works with all support programs; you will have the same financial support you have received from the originator biologic program. 

If you receive an infused medication in one of our clinics, you will continue at the same site with your care team.  If you receive an injectable medication, you will be trained on any device change as each manufacturer has their own patented device. Some of the biosimilar injections offer different features to enhance injection comfort. 

Our pharmacists can review these options with you.  

Based on the worldwide experience and evidence with the biosimilars that exist today, many medical professionals and patient support groups endorse this switch with the understanding that patients are well-informed and educated on any switch.

As always, never hesitate to reach out with any questions or concerns regarding your specialty treatment.  Our team of health professionals and reimbursement specialists are here to support 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.

Many of our patients have indicated they are planning a vacation over the winter months to a sunny destination. It is important to note that medication requiring refrigeration is to be kept at 2-8^oC during your journey. To ensure the medication is not lost in transport, it must be in your carry-on bag and never under the plane where temperature changes are uncertain.  

Carrying empty Ziploc bags with you is also a good idea. You can get ice from the in-flight attendant to help maintain the temperature in your cooler bag, should your ice packs not be enough for the length of the trip. Soft-sided cooler bags may help maintain fridge temperature for 6-8 hours. However, you may be in transit much longer from the time you leave your home until you arrive at your destination.  In preparation for your trip, you may wish to test your cooler using a small thermometer along with ice packs to mimic the time you will be in transit. This will ensure that when you put the medication in the cooler at the time of travel, you can trust it will remain within the suggested temperature range (2-8^oC). 

Biologic medications differ in the amount of time that they can remain at room temperature, ranging from 4 hours to 60 days. If you inadvertently leave your medication out of the fridge, contact us immediately for further direction. Depending on the medication and the amount of time it was left at room temperature, it may not be appropriate to return it to the fridge.

Don’t hesitate to reach out for the pertinent information needed for your specific medication during travel. We are also happy to provide a travel note which may be needed when going through security with a fluid-containing injectable device. Of most importance is to calculate how much medication you will need while away and to order this well in advance of your travel date.

Bon Voyage!

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.