Although the Government of Ontario removed mandatory masking requirements for most indoor settings March 21, 2022, this does not apply to healthcare settings.
Mandatory masking requirements remain in effect for settings such as public transit, healthcare settings, long-term care homes, and congregate care settings. The Charlton Centre clinics are healthcare settings and provide treatment to patients whose immune systems are more vulnerable than the general population, and as such, anyone at a Charlton Centre clinic is required to continue masking. This masking policy will remain in place until further notice.
At Charlton Centres and at Charlton Health, all protocols that support patient safety remain in place. These policies are more stringent than seen in public due to the potential for compromised patients to shed the coronavirus longer, and to potentially be less protected from vaccination.
For example: Patients are not permitted to attend an infusion clinic until 14 days after a positive COVID test and once symptoms have resolved. Patients who have travelled outside of Canada must wait 7 days after their return before coming to the infusion clinic for an appointment.
These types of measures have kept our patients safe throughout the past 2+ years, and we will continue to work to provide safe care and treatment.
If you have any concerns about changes in your health, please contact your clinic in advance of your appointment to be sure you can safely receive your injection or infusion.
A year ago (March 10, 2021) we posted about adalimumab having five biosimilars, we are happy to say that number has increased to eight! There are eight biosimilars approved by Health Canada now. The original adalimumab is Humira (Abbvie), and the biosimilars in alphabetical order include: Abrilada (Pfizer), Amgevita (Amgen), Hadlima (Merck), Hulio (Viatris), Hyrimoz (Sandoz), Idacio (Fresenius Kabi), Simlandi (Jamp), and Yuflyma (Celltrion). Bolded are the newest ones.
As a quick reminder, biologics are protein-based substances that need to be injected/infused, as swallowing them would result in them getting digested in the stomach, which would destroy their effectiveness. Biologics are made by taking a living cell and programming it to make a certain protein, which is very different than how conventional synthetic medications are made. Conventional synthetic medications are based on a very reproducible chemical structure. Biologics, however, are not as easily reproducible because they are grown in a living cell, which results in differences even between batches of the same manufacturer. Companies that want to make a biosimilar need to make their own programmed cell that makes a protein similar to the original biologic.
In order for a company to get a biosimilar approved by Health Canada, the biologic needs to be studied in at least one condition that the original biologic is approved for. Research to prove equal efficacy and safety usually takes 7-8 years, so patients can feel confident using biosimilars for their approved conditions. Additionally, biosimilars have been used safely for multiple conditions around the world for years.
Biosimilars prove they are equally safe and effective in studies; however, each manufacturer may use their own patented device. There can be differences in these devices which includes if the product is citrate-free, latex-free, and/or and the product’s needle gauge.
Citrate is a non-medical ingredient that can be found in some injections. Many people do not get discomfort from injections that contain citrate, but some may. This discomfort may happen during the injection, at the injection site. If someone experienced this with Humira (which contains citrate) then choosing a citrate-free biosimilar may be beneficial, but if there was no discomfort while on Humira, this may not be a deciding factor.
Some individuals have latex allergies, so a deciding factor for those people may be to choose a biosimilar that is latex-free.
Needle gauge refers to the size of the needle hole. Understanding needle gauge is actually counterintuitive to what you may think. The larger the number, the smaller the needle. So, a size 29-gauge (29G) needle is actually smaller than a 27G needle. There are different reasons needles may be different gauges, but it can be due to the size of the protein or molecule that needs to go through it. As the gauge of the needle increases, there tends to be less discomfort during injection. However, the size difference between a 27G needle and a 29G needle may not be noticeable to most.
Biologic or Biosimilar
Citrate-free
Latex-free
Needle gauge
Biologic (Original product)
Humira (AbbVie)
❌
✅
29
Biosimilar
Abrilada (Pfizer)
✅
✅
29
Amgevita (Amgen)
✅
Needle cover is latex derived
27
Hadlima (Merck)
❌
✅
29
Hulio (Viatris)
✅
✅
29
Hyrimoz (Sandoz)
❌
✅
27
Idacio (Fresenius Kabi)
❌
✅
29
Simlandi (Jamp)
✅
✅
29
Yuflyma (Celltrion)
✅
✅
29
Apart from what is in the chart, there are other considerations to be made when deciding which biosimilar to start. These include the biosimilar’s stability at room temperature and the type of autoinjector. Although all these medications need to be stored in the refrigerator, they do have some stability at room temperature, varying between 14-30 days depending on the manufacturer, which may be a consideration for those who travel. Most of the manufacturers have their own patented autoinjectors that differ slightly, but these differences may be important for some people. Many clinics and rheumatologists have demonstrator/training devices of each biosimilar and some individuals may discover they prefer certain devices over others, often due to to personal preference.
With the approval of the newest biosimilars, it can take some time from them being approved to them being available on the market. Your healthcare providers will be able to guide you through the best selection for you at the time that you begin therapy.
Marija Ilic is a Pharmacy Student from the University of Waterloo currently doing a rotation at Charlton Health as part of her final year of studies. Through Marija’s education she has gained experience in both hospital and community pharmacy settings and hopes to find a specialized pharmacy role when she graduates.
As a follow-up to our previous blog about the newly approved treatment for patients with psoriasis, we would like to share useful tips regarding lifestyle and healthy skincare. It is important to note that although these tips may help you manage your psoriasis, they are by no means a replacement for the medical treatments that are prescribed to keep your condition under good control. We have also provided some valuable resources at the end of the post that patients can review to learn more about psoriasis and its treatments.
Skin Care:
Keep nails short and refrain from scratching
Use recommended creams on areas of plaque – do not remove plaque as this can create a worsening of the condition
Choose loose-fitting cotton clothing that reduces rubbing the skin while avoiding nylon, wool, and rough synthetic fabrics
A cool air humidifier in the home can be helpful
Take a daily bath or shower with warm water – never hot!
A minimum of SPF 60 sunblock is suggested when going out in the sun. Products endorsed by the Canadian Dermatology Association are indicated on the label.
Applying a moisturizer once to twice daily is well worth the time! After a bath or shower, apply the moisturizer to the skin while it is still damp in the direction hair grows (hair will lie flat).
Prescription steroids creams/ointments are to be used only when needed. Apply an amount of cream/ointment equal to the size of the tip of the finger for an area equal to the size of the palm of your hand. (For example – an elbow or knee would require a “fingertip” of cream/ointment. Larger areas on the stomach may need a few “finger tips” full)
When prescription creams/ointments are needed, apply them prior to using a moisturizer
Although there are no studied diets or supplements that have evidence in reducing psoriasis, it is important to avoid triggers that have been found to worsen your personal condition
Lifestyle measures include reducing stress, quitting smoking, and maintaining daily exercise (150 minutes per week) along with getting a good night’s sleep.
Stress increases the production of inflammation in the body and can contribute to flares of psoriasis. Quitting smoking is one of the most valuable interventions people can make to improve overall health and inflammatory conditions like psoriasis are improved by quitting smoking. People with active psoriasis also have a greater risk of cardiovascular disease. Smoking can further increase that risk. The most effective way to quit smoking is the use of medication along with counseling.
Sleeping less than 5 hours a night places stress on the body and increases cardiovascular risk. Cognitive Behaviour for Insomnia (CBTi) is one of the most effective strategies to improve sleep.
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.
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.
Psoriasis is an autoimmune condition resulting in chronic inflammation of the skin affecting roughly 1 million Canadians. Mild to moderate cases of psoriasis may be managed through topical treatments (e.g. creams, ointments, gels, foams) like corticosteroids, Vitamin D3 analogues, retinoids, or a combination of these agents. However moderate to severe cases of psoriasis often need to be managed with biologic therapies.
Biologic therapies can vary in targeting and removing different chemical signalling molecules from the inflammation-causing process, resulting in better psoriasis control. One such signalling molecule that seems to be an important target in achieving remission of psoriasis is Interleukin-23 (IL-23). Until May 2021, there were only three biologic agents on the Canadian market that reduced IL-23 function as listed below:
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.
We have spoken many times on our blog about the importance of mental health and how those living with chronic illness often experience mental health concerns at a higher rate. We know throughout the pandemic, these challenges have been amplified as so many immunocompromised people have had to take additional precautions to keep safe over the past two years. The toll that this has taken has been evident to our team in the many conversations we have with patients.
Today is a day that we work to fight the stigma surrounding mental health issues, through Bell’s Let’s Talk initiative. We encourage you to continue this dialogue beyond this annual day and to speak to your healthcare professionals to get the support you need. Always remember that everyone experiences changes in their mental health and there is no shame in asking for help.
If you would like further reading, here are some blog posts we’ve written that may be of assistance:
With the ongoing development of new advanced therapies (e.g. biologics and small molecule medications), most patients are able to achieve a low level of disease activity for many of the commonly occurring autoimmune diseases (e.g. rheumatoid arthritis, ankylosing spondylitis, psoriasis). However, there is still a great need for treatments to manage people suffering from some autoimmune conditions. One example is Sjogren’s syndrome, which is an autoimmune condition that can affect multiple organs of the body.
Some of the symptoms of Sjogren’s include: · Dry eyes · Dry nose · Dry mouth · Fatigue · Joint pain
For a more comprehensive list of symptoms from Sjogren’s please click here.
It is important to remember that symptoms can vary from person to person.
Currently, the options to manage Sjogren’s are limited, and often studies investigating treatments for this condition are unsuccessful. Nonetheless, as recently shared by American rheumatologist Dr. Jack Cush, early results from a preliminary study showed that a biologic treatment, Ianalumab, helped lower disease activity after 24 weeks of treatment.
As pharmacists specializing in autoimmune conditions, we are always excited about findings like this because it gives us a glimpse of the kinds of treatments that may be made available in the near future to best help our patients.
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.
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.
The team at Charlton Health would like to take this opportunity to wish you, your family, and friends all the best of health as we approach the New Year. For those of us in healthcare, it has been an honour to support our many patients during a very challenging time. The volume of phone calls and e-mail questions around COVID vaccinations and the timing of immunosuppressive treatments have been numerous. We would like to thank our team for their tireless efforts in continuing to provide great information to support our patients.
We continue to have over 3,500 people follow our blog: receiving reliable up-to-date information. We truly appreciate the many kind comments we receive and will continue to provide this valuable information sharing. If you have any topics/questions you would like addressed for blogs in the New Year, please let us know.
As we finish 2021, let us take the time to reach out to all those we hold dear, and continue to take care of each other. In the words of Dr. Bonnie Henry of British Columbia, ” Be kind, be calm, be safe!”
On November 24th, Health Canada extended the approval for the non-live shingles vaccine known as SHINGRIX. Beyond the current approval for use in adults aged 50 and over, Shingrix is now approved for the prevention of herpes zoster (shingles) in adults aged 18 years and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression caused by known disease or therapy.
As all the patients we treat for autoimmune diseases have an increased of shingles at an earlier age than the general public, it makes sense to offer this vaccine when the increased risk is identified, whether that be at age 25, 35 or over 50. Adults of any age with increased risk can benefit from this protection. Shingrix is given as a series of 2 injections and full protection occurs approximately 2 weeks after the second dose. Although the standard dosing for the 2 doses is to be given 2-6 months apart, the new Health Canada update allows for individuals who are or will be immunodeficient or immunosuppressed and who would benefit from a shorter vaccination schedule, the second dose can be given 1 to 2 months after the initial dose.
Shingrix is available to many adults through their private insurance plan. Public health supply issued by family physicians is for adults age 65-70. As access to family doctors for vaccination has been reduced during the pandemic, there is an extension to include seniors born in 1949, 1950, and 1951. This is valid until Dec 31, 2022, at which time the oldest eligible patients will be inclusive of 73 years of age. For people who do not have private insurance or fall outside the age category for publicly funded supply, Shingrix can be purchased at any pharmacy without a prescription and administered by a pharmacist certified in injection administration.
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.
Medications provide great benefits for managing inflammatory bowel diseases (IBD) like Crohn’s disease and colitis, and will always be the mainstay in treating these conditions. However, an individualized and healthy diet plan may also provide additional benefits in reducing IBD symptoms. Some of the common foods known to trigger IBD symptoms are: corn and corn-related snacks, spicy foods, oranges/orange juice, whole nuts, as well as fried and fatty foods. While removing or limiting the intake of these foods may help prevent IBD symptoms, patients with IBD may also run the risk of being malnourished. Therefore, there needs to be a fine balance in the diet so that the person can meet their daily nutritional needs without having to worry about worsening symptoms.
Crohn’s and Colitis Canada offers several resources to help make informed decisions about diets for people living with IBD (referenced below). It might also be a good idea to consult a dietitian who would be able to help you plan your daily diets. Once again, medications are the most important tools we have to treat IBD, but it is advised that patients also reap the benefits of healthy diets to manage their IBD.
For more information, visit Crohn’s and Colitis Canada here. An additional source of information for diet is available here.
As the focus on maintaining a low COVID-19 infection rate in our communities remains a priority, Ontario has made third doses of the COVID-19 vaccines available to additional vulnerable populations.
For those listed below, third doses are offered at least 6 months since their last dose:
Individuals aged 70 and over (born in 1951 or earlier)
Health care workers and designated essential caregivers in congregate settings (including long-term care home and retirement home staff and designated caregivers)
Individuals who received a complete series of a viral vector vaccine (two doses of the AstraZeneca vaccine or one dose of the Janssen vaccine) and
First Nation, Inuit and Métis adults and their non-Indigenous household members
As of November 6, 2021, individuals eligible for a booster vaccine dose have multiple options of booking a vaccination appointment. The options are listed below:
COVID-19 vaccination portal/Calling the Provincial Vaccine Contact centre
Contacting their respective public health units*
Indigenous-led vaccination clinics
Select pharmacies
Select family doctor offices
*If you are unsure of which public health unit is associated with your community, you can visit the following website to help you in your search: https://www.phdapps.health.gov.on.ca/phulocator/
For those eligible for a COVID-19 booster dose in Ontario, it is also recommended to get the flu shot at or around the same time.
Additionally, Ontario’s Ministry of Health has made the following recommendations regarding COVID-19 booster vaccine doses:
Either the Moderna or the Pfizer-BioNTech vaccine may be offered as the booster dose irrespective of which vaccine was given in the initial series
If Pfizer-BioNTech is offered as the booster dose, the full dose is recommended**
If Moderna is offered as the booster dose to individuals over 70, those who are immunocompromised or living in long-term care homes, retirement homes, or seniors in congregate living settings, a full dose is recommended**
If Moderna is offered as the booster dose to individuals less than 70 years of age who do not fall under the criteria listed in the bullet point above, a half dose is recommended**
*These recommendations are based on the National Advisory Committee’s Interim Guidance on booster COVID-19 vaccine doses: (https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/statement-guidance-booster-doses/statement-guidance-booster-doses.pdf)
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.
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.
