Helping patients with rheumatoid arthritis transition from biologics to other drugs

A new Canadian consensus-derived monitoring algorithm aims to help pharmacists optimize therapeutic transitions from originator biologics to other originator biologics, biosimilars and Janus kinase inhibitors in patients with rheumatoid arthritis (RA). A recent proliferation of new agents for RA, including the Janus kinase inhibitors (tofacitinib, baricitinib, upadacitinib) and several biosimilars stimulated the need for the document. Switching therapies may be required in the event of a lack of response, an inadequate response or adverse reactions/intolerance to a specific drug. In addition, switches from originator biologics to biosimilars are being mandated in some jurisdictions, in order to achieve cost savings. All of these factors have led to a significant increase in the number of therapeutic transitions that patients undergo. Read: How to optimize bone health in men receiving androgen deprivation therapy The consensus document, developed by a group of pharmacists and rheumatologists, discusses several considerations prior to, during and after transition to another therapy, including the following: How pharmacists can reduce the risk of a nocebo effect, by demonstrating confidence in the transition using positive verbal language and positive body language When pharmacists should refer back to the rheumatologist prior to transition (e.g., if the pharmacist feels there is a significant safety, efficacy or other concern with switching that may lead to a poor outcome) Clinical considerations that pharmacists should be aware of during a therapeutic switch (e.g., mechanism of action and adverse effects of each drug/drug class). How to monitor for efficacy of treatment after the switch. When pharmacists should refer patients for an earlier than scheduled follow up with the rheumatologist. The focal point of the document is a one-page algorithm that is intended to help guide pharmacists through therapeutic transitions in patients with RA. The tool succinctly summarizes pretransition considerations, specific adverse effect considerations for each drug or drug class, a checklist of tasks to complete before the transition, how and when to monitor for efficacy (including tools pharmacists can use to assess disease activity), and when to refer patients to their rheumatologist for earlier than scheduled follow-up (e.g., uncontrolled flare-up, active serious infection, new comorbidity, live vaccination required). Read: Incidence of total joint arthroplasty in rheumatoid arthritis declines in biologics era Use of the clinical guidance and monitoring tool will assist pharmacists in supporting their patients to ensure a successful therapeutic transition to a new RA therapy. The authors note that the algorithm could be used in a hospital, community or specialty setting. The tool is easy to use, with a logical progression from pretransition considerations to post-transition monitoring. The algorithm could be posted in the dispensary or made available on a dispensary computer for quick reference, or printed and used as a checklist when preparing to counsel a patient. Reference 1. Choquette D, Chan J, Bardi M, et al. Monitoring the transition of patients on biologics in rheumatoid arthritis: Consensus guidance for pharmacists. Pharm Pract 2021;19:2377. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455126/pdf/pharmpract-19-2377.pdf (accessed December 20, 2021).

Helping patients with rheumatoid arthritis transition from biologics to other drugs

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