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.

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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.

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Chronic Inflammatory Diseases (CIDs)

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Immunology Introduction

Rheumatoid Arthritis

Psoriasis

Inflammatory Bowel Disease

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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.

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Drugs@FDA [database online]. Silver Spring, MD: FDA; 2017. . Accessed February 9, 2017.

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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.

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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

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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.

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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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