Adalimumab (Humira) update - porthosp.nhs.uk · Saturday 23rd July 2016 10.30-12.30 Managing your...
46
Adalimumab (Humira) update
Transcript of Adalimumab (Humira) update - porthosp.nhs.uk · Saturday 23rd July 2016 10.30-12.30 Managing your...
Aim House Keeping- Fire, Toilet, Refreshments etc Self Reported DAS 28 and DAWN Why Up date? NICE and Adalimumab (Humira) Adalimumab (Humira as a treatment for Arthritis) Bio similar Home Care changes January 2016 Abbvie Care Nurses- visits Phlebotomy roll out What next
Why update?
• NICE Guidance
• Safety- New BSR/BHPR Guidance
• Monitoring
• Bio-Similars- 2016
• Home Care Delivery
1.1 The tumour necrosis factor alpha (TNF-α) inhibitors adalimumab, etanercept and infliximab are recommended as options for the treatment of adults who have both of the following characteristics. Active rheumatoid arthritis as measured by disease activity score (DAS28) greater than 5.1 confirmed on at least two occasions, 1 month apart. Have undergone trials of two disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate (unless contraindicated). A trial of a DMARD is defined as being normally of 6 months, with 2 months at standard dose, unless significant toxicity has limited the dose or duration of treatment. 1.2 TNF-α inhibitors should normally be used in combination with methotrexate. Where a patient is intolerant of methotrexate or where methotrexate treatment is considered to be inappropriate, adalimumab and etanercept may be given as monotherapy. 1.3 Treatment with TNF-α inhibitors should be continued only if there is an adequate response at 6 months following initiation of therapy. An adequate response is defined as an improvement in DAS28 of 1.2 points or more. 1.4 After initial response, treatment should be monitored no less frequently than 6-monthly intervals with assessment of DAS28. Treatment should be withdrawn if an adequate response (as defined in 1.3) is not maintained. 1.5 An alternative TNF-α inhibitor may be considered for patients in whom treatment is withdrawn due to an adverse event before the initial 6-month assessment of efficacy, provided the risks and
Side Effects
Less serious Humira side effects may include:
• mild nausea, vomiting, mild diarrhea, mild stomach pain;
• runny or stuffy nose, cold symptoms; or
• headache.
Side Effects
Stop using Humira and call your doctor at once if you have any of these other serious side effects: • signs of infection (fever, chills, sore throat, body aches, confusion, neck
stiffness, flu symptoms); • shortness of breath with swelling, rapid weight gain; • chest pain, ongoing cough, coughing up mucus or blood; • signs of skin infection such as itching, swelling, warmth, redness, or oozing; • black, bloody, or tarry stools; • changes in mood or personality (in children); • numbness, burning, pain, or tingly feeling; • joint pain or swelling with fever, swollen glands, muscle aches, chest pain,
unusual thoughts or behavior, and/or seizure (convulsions); or • patchy skin color, red spots, or a butterfly-shaped skin rash over your cheeks
and nose (worsens in sunlight).
Side Effects
Get emergency medical help if you have any of these signs of an allergic reaction to Humira: • hives; difficulty breathing; swelling of your face, lips, tongue,
or throat. Stop using Humira and call your doctor right away if you have any of these symptoms of lymphoma: • fever, night sweats, weight loss, tiredness; • pain in your upper stomach that may spread to your shoulder; • easy bruising or bleeding, pale skin, feeling light-headed or
short of breath, rapid heart rate; or • nausea, upper stomach pain, itching, loss of appetite, dark
urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Side Effects
Important Information
• Live Vaccinations/Immunisations
Flu
Shingles
• Antibiotics and Infection
stop whilst taking antibiotics- restart if infection settled 3-5 days after last dose of antibiotic
Remember
• Being investigated for cancer
Let Rheumatology know 0239228 6935
• Pregnancy/ Breast Feeding and Fatherhood
New Guidance 2016 from BSR/BHPR
Bio similar Remicade- Infliximab 2015- Inflectra/ Recemia Enbrel- Etanercept 2016 Adalimumab- Humira 2017
Biologic Optimisation
Appointment 1
Day Case- Reduce dose Appointment 2 (2-3 months)
Appointment 3 (2-3 months)
Continue
Continue
Appointment 1
Review and dose escalation to regain control
Appointment 2 (2-3 months)
Appointment 3 (2-3 months)
Dose reduction/ switch
Review and dose escalation to regain control
Moving Away- out of area
REMEMBER
Remember
Do not put in Freezer compartment
Top of Fridge too cold
Risk of Spillages contaminating Packages
Centre of Fridge in Plastic Container
Keep Fridge door shut and move to alternative fridge
Check Adalimumab Drug Box
Never Stock Pile
Rotate Stock Maximum stock 4-5weeks in fridge at any one time
Travel
Last clinic letter and Blood Tests Results
Put the following in bottom of suitcase
Travel Insurance
Fill 3/4s only Safety pet & children 1st box replacement sharps boxes
Sharps Box
Person reporting faulty injection/ auto injector- contact detail Name____________________________ Address__________________________ _________________________________ Postcode__________________________ Contact Number(s) __________________________________________ ___________________________________________ Please complete 1 copy and put with faulty syringe/ auto injector is single sharps box and return through you home care delivery team- either HealthCare at home Adalimumab 0333 103 9699 Etanercept 0333 103 9599 Certolizumab pegol 0333 103 9838 Golimumab 0333 103 9817 or BUPA Home Care 0845 8888 235 - option 3 Abatacept Tocilizumab 1 copy return to Department of Rheumatology in stamped addressed envelope
Injection/ Auto Injector Failure Reporting
Drug______________________________
Date_____________/__________/_____
Batch Number_____________________
Expiry Date________________________
Details- in what way did the injection/ Auto injector not work- please give as much detail as possible
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Injection/ Auto Injector Failure Reporting
Don’t put the faulty injection or auto injector is your regular sharps bin
Put the faulty injection or auto injector in the small sharps box
Complete two copies of the reporting form (see over)
Telephone your home care delivery company HealthCare at home Adalimumab 0333 103 9699 Etanercept 0333 103 9599 Certolizumab pegol 0333 103 9838 Golimumab 0333 103 9817 BUPA Home Care 0845 8888 235 - option 3 Abatacept Tocilizumab
Arrange collection of the sharps box with the faulty injection/ auto injector with the completed form. Send the 2nd completed form back to Rheumatology in the prepaid envelope
£774.71 per month
Important Telephone Numbers
Patient Advice and Information Line
02392286935
Biologic Co-ordinators 0239228 6437
Home Care Delivery Health Care at Home
Health care at home usually delivery Portsmouth area 2-3 days a week:- Options include Delivery to *Neighbour/ Family Friend * Work
If not an option for you Alternative day to suit your needs including Saturday Deliveries
Experiencing Problems Patient Advice and Information Line
02392286935
Blood Tests
Experiencing Problems Patient Advice and Information Line
02392286935
What else is going on!
Fasten their journey to complete self management
One to One- Support
Group Sessions
Patient and Public Conferences
Individual Personal Care plans
Sign posting to patient organisations
A care plan is an agreement between you and your health professional (or social services) to help you manage your health day to day- ask to speak to the Clinical Nurse Specialists about your personal care plan
The Arthritis and Connective Tissue Disease journey can be complex and involves the care from. Ask for a 1-2-1 appointment with one of the Clinical Nurse Specialists if you feel you need to know more
Enhance
Tired of Being Tired
With over 200 different types of arthritis and connective tissue diseases we recognize the important role that patient organizations play in providing support and
disseminating information to both patients and their care-givers.
Supporting people living with arthritis through self-management is widely recognized as an essential part of any treatment plans. The Department of Rheumatology Acknowledges that "One Size” doesn't fit all and a variety ways to support are available : these include
DaM it Arthritis
Getting to Grip with Arthritis and Connective Tissue Diseases Charity Group
Sessions ACQA NASS
Silver Aqua
Rheumatology OPD Patient Education Programme Getting to Grips- “Staying in Control”
Date Venue Talk
Saturday 16th January 2016 10.30-12.30
Lecture Theatre E-Level Queen Alexandra Hospital PO6 3LY
Managing your Fatigue
Saturday 19th March 2016 10.30-12.30
Managing your Medicines
Saturday 21st May 2016 10.30-12.30
Managing your Flares
Saturday 23rd July 2016 10.30-12.30
Managing your Pain
Wednesday 21st September 2016
Mountbatten Centre, Alexandra Park Twyford Avenue
Portsmouth PO2 9QA
Day to Day Living with Arthritis and Connective Tissue Disease – Patient and public Conference
October
Queen Alexandra Hospital
PO6 3LY
Trust open day
Saturday 26th November 2016 10.30-12.30
Lecture Theatre E-Level Queen Alexandra Hospital
PO6 3LY
Caring for you caring for others
Saturday 17th December 2016 10.30-12.30
Christmas Event
Tired of being Tired
Email [email protected] Write to John Roskilly – Tired of Being Tired, Department of Rheumatology, Queen Alexandra Hospital, Cosham, PO6 3LY
DaM it Arthritis
Keeping you updated
www.porthosp.nhs.uk/departments/Rheumatology/rheumatology.htm
Sign up for Email Communication
Face Book & Twitter
https://twitter.com/QAHospitalNews
https://www.facebook.com/PortHosp
Face Book & Twitter
https://twitter.com/QAHospitalNews
https://www.facebook.com/PortHosp
https://www.youtube.com/channel/UCPj0rJ-EtCgJ2xYonfqI4FA
