Pharmacy News

Entries for May 2015

New Agents for the Management of Psoriasis and Psoriatic Arthritis

by Haya Abu-Seir, Pharm.D., Jessica Probst-Wesolek, Pharm.D., Jordan Masse, Pharm.D., and Jordan Sedlacek, Pharm.D., PGY1 pharmacy residents, St. John Hospital and Medical Center 

Psoriasis is a chronic, inflammatory, immunologic skin disease that affects approximately 2 percent of the United States population. Treatment for psoriasis is tailored to the patient and typically begins with topical corticosteroids for limited psoriasis. Treatment can be escalated to ultraviolet radiation, vitamin D analogues, topical tacrolimus and oral immunosuppressive agents such as methotrexate and cyclosporine. When such modalities fail or are not tolerated, injectable biologic agents are an effective option for most patients. The purpose of this article is to discuss two recently approved agents: secukinumab (Cosentyx™) and apremilast (Otezla®). 

Secukinumab is a human monoclonal antibody that acts as a selective IL-17A antagonist for psoriasis. The regimen consists of five weekly subcutaneous injections followed by an injection every four weeks. While the manufacturer recommends 300 mg per dose, 150 mg may be sufficient for some patients. Common adverse events include upper respiratory infections, nasopharyngitis and diarrhea. 

The study that led to secukinumab’s approval combined two double-blind phase III trials comparing secukinumab (300 mg and 150 mg doses) to placebo and etanercept using the Psoriasis Area and Severity Index (PASI) as a major outcome. In one trial, a significantly higher proportion of patients achieved 75 percent improvement in PASI score using either dose of secukinumab compared to placebo at week 12 (81.6 percent, 71.6 percent and 4.5 percent, respectively). Adversely, the second study demonstrated a similar statistically significant outcome with secukinumab (300 mg and 150 mg) compared to placebo and etanercept (62.5 percent, 51.1 percent, 2.8 percent and 27.2 percent, respectively; p-value < 0.0001). These results indicate that secukinumab is superior to etanercept, a second line agent for psoriasis.

Apremilast (Otezla®), an oral psoriatic arthritis agent, is a selective PDE-4 inhibitor that increases intracellular cAMP and IL-10, and attenuates INF-γ, TNF-α, IL-12 and IL-23. The dose is titrated to 30 mg twice daily and requires renal adjustment. Adverse events include headache, diarrhea, depression, weight loss, upper respiratory infections, nasopharyngitis and nausea. 

There have been two randomized controlled trials investigating the use of apremilast. Both used the American College of Rheumatology Criteria for 20 percent improvement (ACR20) as a primary endpoint. The first study compared 20 mg twice daily or 40 mg daily of apremilast versus placebo. At 12 weeks, both apremilast doses yielded a significantly higher percentage of patients achieving an ACR20 response than placebo (43.5 percent, 35.8 percent and 11.8 percent, respectively). The second study compared 20 mg and 30 mg twice daily of apremilast to placebo for 24 weeks, which also showed significantly more patients achieving ACR20 than placebo. At the end of a 24-week extension period, the treatment groups had a sustained response of achieving ACR 20 at week 52. 

In conclusion, secukinumab and apremilast could be considered for patients who have not responded to first-line treatment of psoriasis and psoriatic arthritis. Further research will elucidate their role in practice. 

References available upon request from MPA office.

Posted in: Professional Practice
Western Michigan Society of Health-System Pharmacists Update

by Kari Vavra, Pharm.D., Western Regional Society Representative 

On May 5, the 46th Annual Western Michigan Society of Health-System Pharmacists (WMSHP) Spring Seminar was held at the Prince Conference Center in Grand Rapids. Attendees received five hours of live continuing education (CE) credit and enjoyed presentations on the topics of sickle cell pain, diabetes treatment, health policy, patient-centered medical homes and HIV. In addition, WMSHP awarded a $1,000 scholarship to a P3 student pharmacist during the event. 

WMSHP held four CE programs this spring. On Jan. 15, at Mangia Mangia in Kalamazoo, Tracey Mersfelder, Pharm.D., BCPS, gave a presentation entitled A Traveling Pharmacist through Time and Place. Then, on Feb. 12, at Spectrum Health Butterworth in Grand Rapids, Ciji Marckini, CPhT, gave a presentation entitled Transforming Care Starting from Medication History. On March 12, at the Bronson Gilmore Center in Kalamazoo, Dean VanLoo, Pharm.D., presented on methicillin-resistant Staphylococcus aureus. Finally, on April 16, at Uccello’s Ristorante in Grand Rapids, two pharmacy residents, Brittany Bowen, Pharm.D., and Phuong Tran, Pharm.D., gave presentations entitled Assessing the Use of a Standardized Order Set for Postoperative Pain Management in Total Arthroplasty Patients and Adjunctive Valproic Acid for the Treatment of ICU Delirium in Intensive Care Patients: A Retrospective Study. A big thank you to all of our speakers! They did a wonderful job! 

WMSHP will be on summer break through August, but will resume meetings in September. For more information about WMSHP or our upcoming programs, please visit www.WMSHP.net.

Posted in: Member News
Updated Changing Perceptions Resource to be Released!
The Michigan Society of Health-System Pharmacists and MPA Public Affairs Committee is excited to announce that the Changing Perceptions resource produced by the Society is being revamped and will soon be released. Changing Perceptions is a promotional and educational brochure that showcases clinical activities of pharmacists. It has been distributed to state and federal legislators, other governmental officials, students, high schools and the general public. The new resource, entitled Pharmacists as Providers, will include three different versions geared toward health care providers, legislators and patients. The document will be provided both in a booklet format as well as one-page flyers on each area covered. The areas highlighted include anticoagulation, asthma, cancer, cardiac care, diabetes, emergency medicine, geriatrics, HIV/AIDS, immunizations, intensive care, nephrology, organ transplant, osteoporosis, pain management, pediatrics, pharmacy technician practice, point-of-care testing and public safety. The health care provider and legislator versions also highlight statistics and cost savings where pharmacists were key to improving patient outcomes in that area of practice. Watch future communications for details on the release of this new resource!
Posted in: Professional Practice
Moving the Profession Forward

by Heather Somand, Pharm.D., BCPS, MSHP Board of Directors 

Have you ever questioned how we’re going to move the profession forward and accomplish the Pharmacy Practice Model Initiative goals when you don’t even have time for lunch during your workday? I’ve had the privilege of participating in many Task Forces and Committees related to advancing pharmacy practice and promoting professional development, and I often spend my drive home from Lansing thinking about that exact question. It sounds really good when you’re away from your day job at a meeting brainstorming how we can advance the profession and make a more significant impact on patient care, but we all return home to the grind of endless e-mails and overdue tasks. So, what’s the solution? Do we leave it up to our supervisors and directors to figure out and we’ll follow suit? Maybe that go-getter colleague will figure it out. Or, maybe I’ll make it to retirement before I really have to worry about it. 

I don’t know what the right answer is, but I’ve concluded a few things for myself on all those drives. First, we need to be engaged in our work environment and consider how we can best contribute to patient care. Don’t exclude yourself from the conversation just because it may not be a pharmacy specific issue. We must be aware of all the issues that present themselves along the continuum of patient care and be willing to brainstorm ideas and solutions to those issues. Will those solutions expand the role of the pharmacist? Potentially. Will they show others at the table the value of a pharmacist’s perspective in solving health-system issues? Hopefully. By being engaged and at the table, we will be better positioned to move the profession forward and garner more resources while doing so. 

Second, we need to remain active learners. Health care is changing much too quickly to assume we don’t need to hone our skills. Take the opportunity to advance your learning and understanding of the world you practice in. Make the continuing education (CE) requirement represent something and seek CE that’s actually meaningful to your work and advancement. Learn from your colleagues at other institutions and participate in those national webinars; maybe you’ll pick something up that will be useful when you’re sitting at the table brainstorming solutions to your institution’s problems. 

Third, we need to raise our hands and put ourselves out there. No one will know we’re interested, willing or able unless we make them aware. Being engaged and offering to help are the first steps toward proving we are capable of so much more than traditional pharmacist roles. As we demonstrate the added value a pharmacist can bring to new practice areas, we will be better positioned to request the additional resources needed to be successful. 

I admit that none of my ideas are going to get my lunch hour back tomorrow; however, I really believe that being engaged and showing others what a valuable resource a pharmacist can be will make them think of using a pharmacist the next time they need to fill a new role in the health system. In turn, we will continue to expand our services and show the many skills a pharmacist can bring to the table. We might not always get a lunch, but the innovative work we’re doing and contributions we’re making to the profession will be worth the cost. For now, I will live with a drive-thru lunch while I’m on the road.

Posted in: Professional Practice
DEA Data Shows a Rise in Pharmacy Robberies

Preliminary 2015 data released by the Drug Enforcement Administration (DEA) suggests that pharmacy robberies are on the rise, particularly in certain states. There were 829 total pharmacy robberies in 2014, with California leading the pack. That’s a 16 percent increase from the 713 total pharmacy robberies in 2013, the majority of which took place in Arizona. Thus far in 2015, Indiana saw the biggest increase in pharmacy robberies, with 34 reported between Jan. 1 and March 31. 

A Pharmacy Times article discussing the data includes an interview with Ken Fagerman, MPA member and author of Staring Down the Barrel: A Pharmacist’s Guide to Diversion and Coping with Robbery. Fagerman developed a pharmacy crime watch in west Michigan, where pharmacies team up with local law enforcement agencies to catch criminals in the act. He also developed a program in South Bend, Indiana in 2012, working collaboratively with local police to curtail pharmacy robberies in the community. While writing his book in 2012, Indiana once again had the most pharmacy robberies in the country, but South Bend reported none for the year, a success he credits to the program as well as police assistance. 

Members are encouraged to read the Pharmacy Times article online for more details, including additional data, tips for handling a robbery situation and the importance of pharmacist involvement in planning, which includes employers ensuring that their pharmacists and stores are prepared for handling robberies.

Posted in: Professional Practice
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