How to inject Taltz

January 29, 2019

Taltz, also known as ixekizumab, is an interleukin-17 blocker that is FDA approved for moderate to severe plaque psoriasis as well as psoriatic arthritis. Other medications in this category include Cosentyx. Today we’re going to go over how to inject Taltz.

Preparing for your injection

Keep your medication stored in the refrigerator until use
- Before injecting medication, take the autoinjector or prefilled syringe out of the refrigerator.
- Allow it to warm up to room temperature.
Pick a place in your house that is clean and has room for your materials (such as the kitchen table).
Wash your hands thoroughly with either:
- Soap & water
- Hand sanitizer
Choose an area to inject – Thigh or Stomach.
- Choose an area that is intact and clear.
- It should not have any of the following:
  - Cuts
  - Scrapes
  - Bruises
  - Psoriasis patches
  - If you have extensive psoriasis, inject between patches
  - Moles
  - Scars
- Please rotate area each time you inject (shown in picture below).

Cleanse chosen area
- Cleanse chosen area with either of the following:
  - Alcohol swab
  - Alcohol and a cotton ball
- Use the chosen alcohol material to “swipe” area
  - Can either use a circular motion or wipe in “strips”
  - Allow the area to dry

How to inject Taltz with an autoinjector/pen

Observe the medication in the window to be sure that it is clear (no cloudiness or crystals)
- You will see a small air bubble within the window, this is normal and will not cause harm when injecting
Remove the cap
Press the tip of the auto-injector down in the skin at a 90 degree angle until it is flush with the skin
Press button and hold for 15 seconds
Viewing window will turn yellow, but continue to hold the button for the full 15 seconds
Lift the auto-injector straight up

Injecting Taltz with a prefilled syringe

Pull off the cap and observe the syringe to be sure that it is clear (no cloudiness or crystals)
Pinch the skin around the injection site and enter at a 45-degree angle
Press the plunger (slowly) to administer the medication
Once the medication is fully administered, the plunger will reach the bottom and a spring will place a cover over the needle

After the injection

Properly dispose of the entire autoinjector/pen or prefilled syringe
- Sharps Container
  - Can be purchased at your local pharmacy
  - Disposal
  - Hospitals may take full sharps containers, ask first.
  - Pharmacies and Doctors’ offices are not allowed to take used syringes or needle
Discard remaining materials in the trash (cap, alcohol swabs, etc.)

For more information regarding Taltz, please follow this link.

Credits

Injection site image: By British Columbia Institute of Technology (BCIT). Download this book for free at http://open.bccampus.ca [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

1 Comments

Self-Injection Videos

How to give yourself Enbrel with the Enbrel Mini

October 30, 2018

Enbrel now comes as a new autoinjector, which can help you decrease medical waste. Today we’re going to learn how to give ourselves Enbrel with the Enbrel Mini. This medication is indicated for the treatment of rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis (JIA).

How to give yourself Enbrel with the Enbrel Mini

Preparing for your injection

Keep your medication stored in the refrigerator until use
- Before injecting medication, take the cartridge out of the refrigerator.
- Allow it to warm up to room temperature.
Pick a place in your house that is clean and has room for your materials (such as the kitchen table).
Wash your hands thoroughly with either:
- Soap & water
- Hand sanitizer
Chose an area to inject – Thigh or Stomach.
- Chose an area that is intact and clear.
- It should not have any of the following:
  - Cuts
  - Scrapes
  - Bruises
  - Psoriasis patches
  - If you have extensive psoriasis, inject between patches
  - Moles
  - Scars
- Please rotate area each time you inject (shown in picture below).

By British Columbia Institute of Technology (BCIT). Download this book for free at http://open.bccampus.ca [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons

Cleanse chosen area
- Cleanse chosen area with either of the following:
  - Alcohol swab
  - Alcohol and a cotton ball
- Use the chosen alcohol material to “swipe” area
  - Can either use a circular motion or wipe in “strips”
  - Allow the area to dry

How to give yourself the injection

Prepare the autoinjector.
Choose how fast you want the medicine to be delivered: fast, medium, or slow.
Press the tab on the autoinjector to open the cartridge site.
With the blue facing down and with the sticker facing you, insert the yellow cartridge into the autoinjector. It should slip in very easily.
Close and remove the blue cap.
Hold the autoinjector like a joystick and press it firmly onto your skin at a 90 degree angle. The autoinjector will chime when ready.
Press the button. The time it takes to deliver the medication will differ. The injection is complete when you hear the second chime.

What to do after the injection

Lift the autoinjector up from skin.
The autoinjector will open and release the cartridge.
Place the cartridge into a sharps container
- If you do not have a sharps container available, contact your pharmacy/doctor’s office about obtaining one
  - In the meantime, you may use an old coffee container with a lid
- Some hospitals take full Sharps Containers for disposal. Here at the office we do not. Contact your pharmacy for more information about the disposing of your Sharps Container.
Discard remaining materials in the trash (cap, alcohol swabs, etc.)

Need more information?

Please follow the link to connect with the manufacturer’s website.

If you have any concerns about your medication (e.g., excessive pain, swelling, redness bruising, bleeding, fever, breathing problems), please contact your rheumatologist.

Medical Disclaimer

Diseases and Conditions When to see a rheumatologist

8 Warning signs of psoriatic arthritis

April 10, 2018

Most people think psoriasis is an autoimmune disease that only affects the skin, but did you know that about 26% of people also have psoriatic arthritis? Did you know that psoriatic arthritis is more common than rheumatoid arthritis?[1] What are the signs of psoriatic arthritis?

8 Warning signs of psoriatic arthritis

1. Having nail psoriasis

A recent Japanese study tried to find risk factors that predispose people with psoriasis to develop psoriatic arthritis. First, they found that about 17% of people with psoriasis also had psoriatic arthritis. Furthermore, they found that people who had psoriasis involving their nails had a higher chance of having psoriatic arthritis: 29% (PsO) versus 62% (PsA). In conclusion, they found that people who had high uric acid levels also had a higher risk of having psoriatic arthritis 9% (PsO) versus 22% (PsA).[2]

How does nail psoriasis look like?

Nail psoriasis can sometimes mimic nail fungus. It can also make pits in the nail and can cause nails to break very easily.

Follow the link for examples.

2. Having autoimmune joint pain

Autoimmune joint pain typically causes swelling and warmth of the joints. People often describe stiffness that lasts more than one hour. Symptoms are worse in the morning. Furthermore, psoriatic arthritis can affect almost any joint: knuckles, toes, wrists, ankles, knees, etc.

3. Inflammation involving the tips of your fingers

I’m referring to the tips of the fingers, also called the distal interphalangeal joints. Osteoarthritis (i.e., wear and tear arthritis) in the hands can sometimes cause similar symptoms. Typically, the symptoms in psoriatic arthritis happen more quickly and typically there is more swelling and redness.

4. “Sausage fingers”

This happens when the tendons and ligaments that supply fingers get inflamed. This can happen in a variety of different diseases such as ankylosing spondylitis, reactive arthritis, inflammatory bowel disease, infection, sickle cell anemia, sarcoidosis, and gout to name a few. Follow the link to look at some examples.

5. Having inflammation of tendons and ligaments

Enthesitis means inflammation of connective tissue that attaches to bones. These include tendons, ligaments, and bursae. Most cases of enthesitis are due to injury or overuse. Think of a marathon runner with Achilles tendinitis or a tennis player with tennis elbow. In psoriatic arthritis, the immune system attacks these connection points. So you can have someone who leads a fairly sedentary life who suddenly develops Achilles tendinitis on both feet, runner’s knee, and plantar fasciitis happening all at once, for no good reason.

6. Autoimmune back pain

Inflammation involving the back causes symptoms that are very different from your usual mechanical back pain. Here are some key features:

Back pain present for more than three months.
Pain improves with exercise.
Pain improves with anti-inflammatory medications like naproxen or ibuprofen.
Rest usually worsens the pain.
Back pain that wakes you up during the second half of the night.
Pain and prolonged stiffness in the morning, typically lasting more than an hour.
Alternating deep buttock pain.

7. History of uveitis

Uveitis is a general term used to describe a group of diseases that cause inflammation in the eye: uvea, lens, retina, optic nerve, and the vitreous. Depending on where the inflammation is happening, your ophthalmologist may describe it as anterior uveitis, intermediate uveitis, posterior uveitis, or panuveitis. As a result, people can experience blurry vision, eye pain, redness, sensitivity to light, and sometimes headaches.

Uveitis is associated with many diseases including psoriasis and psoriatic arthritis. Sometimes uveitis is the first manifestation of psoriatic arthritis. This is why I’ve included this topic here, even though technically it isn’t arthritis. It’s important to keep this in the back of your mind.[3] While uveitis is one of the signs of psoriatic arthritis, psoriatic arthritis is not the most common cause of uveitis.

8. Having a first degree family member with psoriasis or psoriatic arthritis

This means mom, dad, siblings, and children. Furthermore, other diseases also increase risk. These include Crohn’s disease, ulcerative colitis, ankylosing spondylitis, reactive arthritis, and uveitis.

Call to action

In conclusion, if you think you may have psoriatic arthritis, I encourage you to contact a rheumatologist to get tested. Time is of the essence. Click on “FIND A RHEUMATOLOGIST” above to search the American College of Rheumatology database to find a rheumatologist near you.

Want to learn more? The Arthritis Foundation and the Arthritis Society are also great starting points.

Medical Disclaimer

References

[1] Rheumatology Secrets, 3^rd edition

[2] Tsuruta N, Imaguku S, Narisawa Y. Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients. J Dermatol. 2017 Jul 10. doi: 10.1111/1346-8138.13968. [Epub ahead of print]

[3] https://nei.nih.gov/health/uveitis/uveitis

Self-Injection Videos

How to inject Stelara

January 2, 2018

Continuing with our self-injection series, Dr. Farrell teaches us how to inject Stelara. Stelara, also known as ustekinumab, is a biologic medication designed to block interleukin-12 and interleukin-23. Stelara is currently FDA approved for moderate to severe plaque psoriasis, psoriatic arthritis, and moderate to severely active Crohn’s disease. The medication comes as a prefilled syringe and there are two different doses: 45 mg and 90 mg depending on your weight.

Preparing for your injection

Keep your medication stored in the refrigerator until use
- Before injecting medication, take the prefilled syringe out of the refrigerator.
- Allow it to warm up to room temperature.
Pick a place in your house that is clean and has room for your materials (such as the kitchen table).
Wash your hands thoroughly with either:
- Soap & water
- Hand sanitizer
Choose an area to inject – Thigh or Stomach.
- Choose an area that is intact and clear.
- It should not have any of the following:
  - Cuts
  - Scrapes
  - Bruises
  - Psoriasis patches
  - If you have extensive psoriasis, inject between patches
  - Moles
  - Scars
- Please rotate area each time you inject (shown in picture below).

Cleanse chosen area
- Cleanse chosen area with either of the following:
  - Alcohol swab
  - Alcohol and a cotton ball
- Use the chosen alcohol material to “swipe” area
  - Can either use a circular motion or wipe in “strips”
  - Allow the area to dry

Injecting Stelara with a prefilled syringe

Pull off the cap and observe the syringe to be sure that it is clear (no cloudiness or crystals)
Pinch the skin around the injection site and enter at a 45-degree angle
Press the plunger (slowly) to administer the medication
Once the medication is fully administered, the plunger will reach the bottom and a spring will place a cover over the needle

After the injection

Properly dispose of the entire prefilled syringe
- Sharps Container
  - Can be purchased at your local pharmacy
  - Disposal
  - Hospitals may take full sharps containers, ask first.
  - Pharmacies and Doctors’ offices are not allowed to take used syringes or needle
Discard remaining materials in the trash (cap, alcohol swabs, etc.)

For more information regarding Stelara, please follow this link.

Credits

Jessica Farrell, PharmD. Clinical Pharmacist, The Center for Rheumatology/Associate Professor, Albany College of Pharmacy and Health Sciences

With the help of Autumn Koniowka. Doctor of Pharmacy Candidate Class of 2018, Albany College of Pharmacy and Health Sciences, and Megan Phillips. Doctor of Pharmacy Candidate Class of 2018, Albany College of Pharmacy and Health Sciences.

A special thanks to Tammy Garren, PhD. Instructional Designer, Center for Innovative Learning, Albany College of Pharmacy and Health Sciences.

Medical Disclaimer

Self-Injection Videos

How to inject Cosentyx

December 5, 2017

Continuing with our self-injection series, Dr. Farrell teaches us how to inject Cosentyx. Cosentyx, also known as secukinumab, is a monoclonal antibody that blocks interleukin-17. This is a cytokine that is overactive in diseases such as psoriasis, psoriatic arthritis, and ankylosing spondylitis. That being said, Cosentyx is FDA approved for ankylosing spondylitis, moderate to severe plaque psoriasis, and psoriatic arthritis. Cosentyx comes as a pen or autoinjector as well as the prefilled syringe. It also comes in two different doses: 150 mg and 300 mg.

Preparing for your injection

Keep your medication stored in the refrigerator until use
- Before injecting medication, take the autoinjector or prefilled syringe out of the refrigerator.
- Allow it to warm up to room temperature.
Pick a place in your house that is clean and has room for your materials (such as the kitchen table).
Wash your hands thoroughly with either:
- Soap & water
- Hand sanitizer
Choose an area to inject – Thigh or Stomach.
- Choose an area that is intact and clear.
- It should not have any of the following:
  - Cuts
  - Scrapes
  - Bruises
  - Psoriasis patches
  - If you have extensive psoriasis, inject between patches
  - Moles
  - Scars
- Please rotate area each time you inject (shown in picture below).

Cleanse chosen area
- Cleanse chosen area with either of the following:
  - Alcohol swab
  - Alcohol and a cotton ball
- Use the chosen alcohol material to “swipe” area
  - Can either use a circular motion or wipe in “strips”
  - Allow the area to dry

Injecting Consentyx with an autoinjector/pen

Observe the medication in the window to be sure that it is clear (no cloudiness or crystals)
- You will see a small air bubble within the window, this is normal and will not cause harm when injecting
Remove the cap
Press the tip of the auto-injector down in the skin at a 90 degree angle until it is flush with the skin
Press button and hold for 15 seconds
Viewing window will turn yellow or blue, but continue to hold the button for the full 15 seconds
Lift the auto-injector straight up

Injecting Consentyx with a prefilled syringe

Pull off the cap and observe the syringe to be sure that it is clear (no cloudiness or crystals)
Pinch the skin around the injection site and enter at a 45-degree angle
Press the plunger (slowly) to administer the medication
Once the medication is fully administered, the plunger will reach the bottom and a spring will place a cover over the needle

After the injection

Properly dispose of the entire autoinjector/pen or prefilled syringe
- Sharps Container
  - Can be purchased at your local pharmacy
  - Disposal
  - Hospitals may take full sharps containers, ask first.
  - Pharmacies and Doctors’ offices are not allowed to take used syringes or needle
Discard remaining materials in the trash (cap, alcohol swabs, etc.)

For more information regarding Cosentyx, please follow this link.

Credits

Jessica Farrell, PharmD. Clinical Pharmacist, The Center for Rheumatology/Associate Professor, Albany College of Pharmacy and Health Sciences

A special thanks to Tammy Garren, PhD. Instructional Designer, Center for Innovative Learning, Albany College of Pharmacy and Health Sciences.

Medical Disclaimer

Journal Club

Is tofacitinib effective in treating psoriatic arthritis?

November 7, 2017

As you can recall, psoriatic arthritis is a type of autoimmune disease that affects people with psoriasis. In certain cases, it can look like rheumatoid arthritis, but it is very different condition. Rheumatologists use medications like sulfasalazine, methotrexate, Otezla, as well as multiple TNF inhibitors such as Enbrel and Humira to treat psoriatic arthritis. Other medications include Cosentyx, an interleukin 17 inhibitor, as well as Orencia.

Tofacitinib or adalimumab versus placebo for psoriatic arthritis

Recently, researchers studied whether tofacitinib, also known as Xeljanz, could also give some benefit for people with psoriatic arthritis. A recent study published in the New England Journal of medicine reported the results of the oral psoriatic arthritis trial (OPAL) Broaden, the phase 3 trial which evaluated the efficacy and safety of tofacitinib and adalimumab, also known as Humira, compared to placebo. Here are the results.

Methods

Design

The study lasted 12 months.
Everyone had to be on at least one conventional or non-biologic DMARD such as methotrexate, sulfasalazine, or leflunomide.
The trial was a randomized, placebo-controlled, double-blind phase 3 trial.
People were randomly assigned to receive the following regimens:
- Tofacitinib 5 mg taken orally twice daily
- Tofacitinib 10 mg taken orally twice daily
- Adalimumab 40 mg subcutaneously once every two weeks
- Placebo with a switch to 5 mg dose of two presented at month three, or placebo with a switch to 10 mg dose of two presented at month three
Everyone had to be on a stable background dose of either, methotrexate, sulfasalazine, or leflunomide.

The trial was sponsored by Pfizer.

Primary and secondary endpoints

The two primary endpoints assessed at month three were:
- The percentage of people who achieved an American College of Rheumatology 20 (ACR20) response
- And the change from baseline Health Assessment Questionnaire – Disability Index (HAQ-DI).

The ACR20 is a composite measure defined as both improvement of 20% in the number of tender and number of swollen joints, and a 20% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure [most often Health Assessment Questionnaire (HAQ)], visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein (CRP).

ACR50 and ACR70 are the same instruments with improvement levels defined as 50% and 70% respectively versus 20% for ACR20

Secondary endpoints included the amount of people who achieved an ACR50 or more and an ACR70 or more. The researchers looked at the improvement in people’s psoriasis as well as enthesitis (i.e., inflammation of tendons, ligaments, and bursae).
The researchers also looked at x-rays of the hands and feet at baseline and at month 12, to see whether they had worsened on treatment.
They assessed safety by means of spontaneous reporting of adverse events – physical examinations, and clinical laboratory test.

Results

Efficacy

373 people completed the trial.

At 3 months, ACR20 response was:
- 50 % in the 5-mg tofacitinib group
- 61% in the 10-mg tofacitinib group
- 52% in the adalimumab group
- 33% in the placebo group
At 3 months, the ACR 50 response was:
- 28% in the 5-mg tofacitinib group
- 40% in the 10-mg tofacitinib group
- 33% in the adalimumab group
- 10% in the placebo group
At 3 months, the ACR70 response was:
- 17% in the 5-mg tofacitinib group
- 14% in the 10-mg tofacitinib group
- 19% in the adalimumab group
- 5% in the placebo group
At month 12, 90% among people who received tofacitinib or adalimumab did not show any worsening of their disease on x-ray.
Both tofacitinib and adalimumab performed better than placebo
They both performed similarly but in all fairness, the study wasn’t powered to accurately compare the two.

Safety

At 3 months, the percentage of people with adverse events:
- 39% in the 5-mg tofacitinib group
- 45% in the 10-mg tofacitinib group
- 46% in the adalimumab group
- 35% in the placebo group
At 3 months serious adverse events occurred in:
- 3% of the 5-mg tofacitinib group
- 1% of the 10-mg tofacitinib group
- 1% of the adalimumab group
- 1% of the placebo group
At 12 months, the percentage of people with serious adverse events
- 7% of people in the 5-mg tofacitnib group
- 4% of the people in the 10-mg tofacitinib group
- 8% in the adalimumab group
The most common adverse events were sinusitis, upper respiratory tract infections, and headaches.
One cardiac arrest happened in the placebo group at month 4, i.e., 1 month after switching to tofacitinib.
There were 4 cases of shingles that occurred in the groups receiving tofacitinib.
Three cases of cancer occurred: day 1, day 11, and day 231 of the trial.

Conclusion

Tofacitinib is effective in treating psoriatic arthritis at 3 months and after one year of treatment. The rates of adverse effects are more than placebo but comparable to current standard of care.

References

Mease P, et al. Tofacitinib or adalimumab versus placebo for psoriatic arthritis.N Engl J Med. 2017 Oct 19;377(16):1537-1550.

Medical Disclaimer

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