Transcript Remicade, Orencia, actemra and the need for

Emily Iseman
Intern Mentor Program
Mount Hebron High School
Arthritis Care Specialists of Maryland
Mentor: Kathleen Skolnik
Upcoming Information
Rheumatoid Arthritis
 Treatment Options
 Biologic Drugs
 Arthritis Care Specialists of Maryland
 Surveying the Patients
 Conclusions Drawn
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Rheumatoid Arthritis
Autoimmune
 Pain, swelling, stiffness
 Medications:
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 Oral
 Subdermal Injections
 Intravenous
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ACR 20
 20% decrease in swelling
 20% decrease in pain &
disability
Methotrexate
Liver toxicity
 Immune suppressant
 Disease Modifying Antirheumatic Drug
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Biologic Drugs
Attack the immune system
 Animal proteins
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Remicade
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TNF-inhibitor (TNF attacks healthy tissue)
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1st line of infusions used
Orencia
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T cell inhibitor (reduces inflammation, swelling &
pain)
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2nd line of infusions used
Actemra
Blocks interleukin 6 (reduces
inflammation
 3rd line of infusions used

Arthritis Care Specialists of
Maryland
Mentor: Kathleen Skolnik
 Priming IV Tubing
 Setting up Trays
 Monitoring Patient Vitals
 Developing Relationships
with Patients

Surveying Patients
Gender
 Age
 Current Biologic
 Past Biologics
 Methotrexate?
 Pain and Mobility
 HAQ 20-item Disability Scale

Results - Remicade

Remicade and Methotrexate (18)
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Average HAQ- .885
HAQ = 0 – 3
Pain improved w/ MTX? - 3
Mobility Improved w/ MTX? - 10
Remicade (12)
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Average HAQ- .139
HAQ = 0 – 4
Pain improved w/ MTX? - 0
Mobility Improved w/ MTX? - 0
Results - Orencia
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Orencia and Methotrexate (4)
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Average HAQ- .25
HAQ = 0 – 1
Pain improved w/ MTX? - 1
Mobility Improved w/ MTX? - 2
Orencia (1)
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Average HAQ- n/a
HAQ = 0 – n/a
Pain improved w/ MTX? – no difference
Mobility Improved w/ MTX? – no difference
Results - Actemra
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Actemra and Methotrexate (3)
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Average HAQ- 1.25
HAQ = 0 – 1
Pain improved w/ MTX? - 0
Mobility Improved w/ MTX? - 0
Actemra (2)
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Average HAQ- 1.875
HAQ = 0 – 0
Pain improved w/ MTX? – no difference (2)
Mobility Improved w/ MTX? – no difference (2)
What am I doing with this?
Pamphlet!
 Presenting Pamphlet to doctors/nurses
at my internship

Conclusion

Methotrexate does not need to be paired
with Remicade or Actemra (no
difference or better feelings and HAQ),
and there was not enough information
collected to determine the difference
with Orencia
Works Cited
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Arthritis Foundation. "Treatment Guides." Arthritis Today. Arthritis Foundation, 2013. Web. 11 Dec. 2013.
Arthritis Foundation. "What Is Rheumatoid Arthritis?" Arthritis Today. Arthritis Foundation, 2013. Web. 11 Dec. 2013.
American College of Rheumatology. "Tocilizumab (Actemra)." American College of
Rheumatology. American
College of Rheumatology, Mar. 2013. Web. 21 Nov. 2013.
Arnett, DK, Bridges, SL, Brown, EE, Danila, MI, Halilova, KI, Hwang, MH, and Morgan, SL. "Markers of Treatment
Response to Methotrexate in Rheumatoid Arthritis: Where Do We Stand?" International Journal of Rheumatology 2012
(n.d.): n. pag.EBSCOhost. Medline, 9 July 2012. Web. 23 Sept. 2013.
Bingham, Clifton. "Remicade without Methotrexate?" Johns Hopkins Arthritis Center. Johns Hopkins, 26
Sept. 2011. Web. 18 Dec. 2013.
Bristol-Myers Squibb. "Indications and Important Safety Information for
ORENCIA® (abatacept)." ORENCIA®
(abatacept) Official Site. Bristol-Myers
Squibb, Sept. 2013. Web. 13 Nov. 2013.
"C-Reactive Protein (CRP)." WebMD. WebMD, 18 Mar. 2010. Web. 16 Oct. 2013.
Dowshen, Steven. "Blood Test: Comprehensive Metabolic Panel." Kids Health. Nemours, Feb. 2011. Web. 2 Oct. 2013.
"Drug-Induced Hepatotoxicity." Drug-Induced Hepatotoxicity. WebMD, n.d. Web. 24 Mar. 2014.
Genentech. "Proven to Help Relieve Symptoms." ACTEMRA (tocilizumab). Genentech, 2013.
Web. 06 Nov.
2013.
George, Stephen W. "Methotrexate at Arthritis Care Specialists of Maryland." Personal interview. 22 Oct. 2013.
Healthwise. "Complete Blood Count (CBC): Results and Interpretation." WebMD. WebMD, 03 Aug. 2010. Web. 23 Oct.
2013.
Jones, G., A. Sebba, J. Gu, M. Lowenstein, A. Calvo, J. Gomez-Reino, D. Siri, M. Tomsic, E. Alecock, T. Woodworth,
and M. Genovese. "Comparison of Tocilizumab Monotherapy versus Methotrexate Monotherapy in Patients with
Moderate to Severe Rheumatoid Arthritis: The AMBITION Study." Ann Rheum Dis 69.01 (2010):
69+. Http://ard.bmj.com/. BMJ Publishing Group Ltd & European League Against Rheumatism, 19 Feb. 2009. Web.
Jones, Kelly W., and Supen R. Patel. "A Family Physician's Guide to Monitoring Methotrexate." A Family Physicians'
Guide to Monitoring Methotrexate. American Family Physician, 1 Oct. 2000. Web. 25 Sept. 2013.
Kavanagh, Ronan. "Methotrexate." YouTube. Western Rheumatology, 17 Feb. 2012. Web. 28 Oct. 2013.
"Methotrexate (Anti-Rheumatic) Oral." WebMD. WebMD, 2013. Web. 09 Oct. 2013.
"Methotrexate." Livertox. National Library of Medicine, 18 July 2013. Web. 25 Sept. 2013.
"Remicade Medication Guide." Remicade.com. Janssen Biotech, Inc., 29 July 2013. Web. 12
Sept. 2013
Skolnik, Kate. Personal interview. 2 Oct. 2013.
Walsh, Nancy. "Methotrexate Not Needed with Actemra in RA." MedPage Today. MedPage
Today, 18 Nov.
2011. Web. 04 Dec. 2013.