Chronic Inflammatory Disease - ProCE
Chronic Inflammatory Disease:
An Introduction
Developed by Mike Crowe, PharmD, MBA, CSP, FMPA &
Alissa Johnson, PharmD Candidate Presented by
Mike Crowe , PharmD, MBA, CSP, FMPA
Speaker Disclosure
Michael Crowe has nothing to disclose.
1
Objectives
1. Summarize available treatments for the chronic inflammatory diseases (CIDs) rheumatoid arthritis (RA), plaque psoriasis, and Crohn's disease.
2. Describe the etiology of CIDs. 3. Outline the pathophysiology of CIDs. 4. Explain the pharmacologic approach to treating CIDs.
3
Chronic Inflammatory Diseases (CIDs)
4
2
Immunology Introduction
Rheumatoid Arthritis
Psoriasis
Inflammatory Bowel Disease
5
Tumor Necrosis Factor (TNF)- Inhibitors
Medication Name Drug Class
Remicade? (infliximab) TNF Inhibitor
Route
Rheumatoid Arthritis
IV
*, MTX
q 4-8 wks
Plaque Psoriasis
*
q 8 wks
Psoriatic Arthritis
*
q 8 wks
Crohn's Disease
*
q 8 wks
Ulcerative Colitis
*
q 8 wks
Enbrel? (etanercept) TNF Inhibitor
SC
*
q week
q week
q week
Humira?
(adalimumab)
SC
*
*
*
TNF Inhibitor
q 1 or 2 wks qow
qow
qow
qow
Simponi? [AriaTM] (golimumab) TNF Inhibitor
SC [IV] [*], MTX
q 4 [8] wks
q 4 wks
*
q 4 wks
Cimzia? (certolizumab pegol) SC
*
TNF Inhibitor
q 2 or 4 wks
*
*
qow
q 4 wks
*Induction dose is indicated; MTX = dosed with methotrexate
Micromedex [database online]. Greenwood Village, CO: Truven Health Analytics ; 2017. . Accessed February 8, 2017.
6
Drugs@FDA [database online]. Silver Spring, MD: FDA; 2017. . Accessed February 9, 2017.
3
Specialty Medications for CIDs
Medication Name Drug Class
Route
Rheumatoid Arthritis
Plaque Psoriasis
Psoriatic Arthritis
Crohn's Disease
Ulcerative Colitis
Kineret? (anakinra) IL-1 Inhibitor
Actemra? (tocilizumab) IL-6 Inhibitor
SC
qd
SC [IV]
q 1 or 2 wks
*Induction dose is indicated; MTX = dosed with methotrexate
Cosentyx?
(secukinumab)
SC
IL-17A inhibitor
*
q 4 wks
* +/- MTX
q 4 wks
TaltzTM
(ixekizumab)
SC
IL-17A Inhibitor
*
q 4 wks
Stelara? (ustekinumab) IL-12/23 Inhibitor
SC, IV
*
q 12 wks
*
q 12 wks
*
q 8 wks
Otezla?
(apremilast)
PO
PDE-4 Inhibitor
*
*
bid
bid
Micromedex [database online]. Greenwood Village, CO: Truven Health Analytics ; 2017. . Accessed February 8, 2017. Drugs@FDA [database online]. Silver Spring, MD: FDA; 2017. . Accessed February 9, 2017.
Specialty Medications for CIDs
Medication Name Drug Class
Xeljanz? [XR] (tofacitinib) JAK Inhibitor
Rituxan? (rituximab) CD20 of B cell
Orencia? (abatacept) CD80/CD86 of T cell
Tysabri? (natalizumab) Integrin Antagonist
Entyvio? (vedolizumab) Integrin Receptor
Antagonist
Route
Rheumatoid Arthritis
PO
*
qd or bid
IV
* , MTX
q 16-24 wks
SC, IV
qw
IV
IV
Plaque Psoriasis
Psoriatic Arthritis
Crohn's Disease
Ulcerative Colitis
q 4 wks
*
q 8 wks
*
q 8 wks
*Induction dose is indicated; MTX = dosed with methotrexate
Micromedex [database online]. Greenwood Village, CO: Truven Health Analytics ; 2017. . Accessed February 8, 2017. Drugs@FDA [database online]. Silver Spring, MD: FDA; 2017. . Accessed February 9, 2017.
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Biologic Product Safety
Common Adverse Effects
? Infection
? Upper respiratory tract ? Sinusitis
? Injection site reactions
? Pain, redness, itching ? Infusion reactions
? Headache
Warnings/Precautions
? Serious infections ? Hepatitis B virus reactivation ? Allergic reactions ? Malignancies ? Moderate to severe CHF
? TNF Inhibitors
? Demyelinating disease ? Few drug interactions
Micromedex [database online]. Greenwood Village, CO: Truven Health Analytics ; 2017. . Accessed February 8, 2017.
Self-Administered Biologic Products
? Injection technique
? Remove device from fridge for 15-30 minutes prior to injection ? Wash and dry hands ? Select an appropriate injection site ? Do not inject into skin that is bruised, sore, red, or hard ? If you have psoriasis, do not inject directly into any lesions ? Rotate injection sites each time you inject ? Wipe the injection site with an alcohol swab and allow area to dry ? Inject using the technique appropriate for the specific device ? Dispose the device in a sharps disposal container immediately after
use ? Do not rub the injection site
Micromedex [database online]. Greenwood Village, CO: Truven Health Analytics ; 2017. . Accessed February 8, 2017.
5
Biologic Product Counseling Points
? Storage ? Avoid live vaccines during treatment ? Notify physician of signs/symptoms of the following:
? Infection ? Hypersensitivity ? Hepatitis B reactivation ? Heart failure ? Demyelination ? Malignancy
? Expectations
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Micromedex [database online]. Greenwood Village, CO: Truven Health Analytics ; 2017. . Accessed February 8, 2017.
Chronic Inflammatory Disease
RHEUMATOID ARTHRITIS
6
Rheumatoid Arthritis
? Chronic autoimmune disorder of the joints ? Symmetrical presentation
? Painful inflammation ? Joint deformity
? 1.3 million affected in US
? Women > Men (3:1)
? Races equally affected
Singh JA, et al. American College of Rheumatology. Arthritis Care & Research. 2015;68(1):1-25. Wahl K, Schuna AA. Rheumatoid Arthritis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 10e. New York, NY: McGraw-Hill; 2017.
Articular Presentation
? Pain/tenderness ? Swelling ? Morning stiffness ? Walking difficulties ? Joint deformity
Hands Elbows Knees
Wrists Shoulders
Ankles
Singh JA, et al. American College of Rheumatology. Arthritis Care & Research. 2015;68(1):1-25.
Wahl K, Schuna AA. Rheumatoid Arthritis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiolo1g4ic
Approach, 10e. New York, NY: McGraw-Hill; 2017.
7
Pathophysiology
Immune System Fails to Recognize
Self
Increased Inflammatory
Response
Inflammation of Synovial Tissues
Cartilage and Bone Erosion
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Singh JA, et al. American College of Rheumatology. Arthritis Care & Research. 2015;68(1):1-25.
Rheumatoid Arthritis Treatment Options
Symptomatic Therapies
Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs)
Corticosteroids
Disease Modifying Antirheumatic Drugs (DMARDs)
Traditional DMARDs
Biologics
Singh JA, et al. American College of Rheumatology. Arthritis Care & Research. 2015;68(1):1-25.
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