Disease Modifying Anti-Rheumatic Drugs (DMARDs)

 

Inflammatory arthritis is a painful and debilitating auto-immune disease that causes swelling and damage to cartilage and bone around the joints. It is a chronic condition with no cure, but medications can control the inflammation, helping to prevent long-term damage and disability.

DMARDs reduce the inflammation in your joints to help prevent pain, swelling and prevent long-term damage. Not all medications work for everyone and there are certain restrictions on how we use the treatments.

There are guidelines by the Scottish Intercollegiate Guidelines Network (SIGN) and the British Society for Rheumatology (BSR) that determine how medications are used for Inflammatory Arthritis. There are also local pharmacy guidelines as to how we use these medications.

There are 3 types of DMARDs:

1. Conventional Synthetic DMARDs (csDMARDs):

 

• Methotrexate
• Sulfasalazine
• Hydroxychloroquine
• Leflunomide

 

These treatments are used initially for Inflammatory Arthritis and can take up to 3 months to have full effect. They come in tablet form, but methotrexate is also available as an injection. You may be given a Steroid injection or Steroid tablets to take until these drugs take effect.

Your chest X-ray is normally taken before your start these medications. Your blood tests will be checked before and frequently when you begin some of these medications and if no problems the frequency of blood tests will be reduced.

 

2. Biologic DMARDs (bDMARDs):

 

• Anti TNF:

Adalimumab

Certolizumab

Etanercept

Golimumab

Infliximab

• IL 6 Inhibitors:

Sarilumab

Tocilizumab

• IL17 Inhibitors:

Ixekizumab

Secukinumab

• IL12 and 23 Inhibitor:

Ustekinumab

• IL23 Inhibitor:

Guselkumab

• T-Cell co-stimulator Inhibitor:

Abatacept

• B-cell depletors:

Belimumab

Rituximab

 

bDMARDS block the activity of key chemicals, cells or proteins involved in inflammation that cause joint swelling and other symptoms. They are powerful and specific therapies that target very particular parts of the immune system. They are divided into groups which relate to the protein or white blood cell they block in the immune system.

These treatments are used if you cannot tolerate or have side effects to the csDMARDs or if these medications are not enough to control your inflammatory arthritis. They can take from 2 to 16 weeks to have full effect. Some treatments are given by an injection into the layer of fat between the skin and muscle. This is called a subcutaneous injection and is usually given into the thigh or abdomen. You will be taught how to inject. Injections are delivered to your home address by a Home Delivery Company. Your nurse will inform you of the name of the company.

Others are given into the vein through a drip. This is called an intravenous infusion and is given in the rheumatology day unit at Ashgrove House, or the Macmillan unit in the Balfour Hospital if you live in Orkney. Currently there are no facilities at Dr. Grays hospital in Elgin to administer the infusions. You will be monitored throughout your infusion and you should inform the nurses straight away if you feel unwell.  

Your Disease Activity Score (DAS28, tender and swollen joint count or BATH Indices) may be calculated and needs to be in the moderate (for limited bDMARDS) or severe disease activity category level before you can start these medications.

The DAS28 score | NRAS | Disease Activity Score

Bath Indices | National Axial Spondyloarthritis Society (nass.co.uk)

 

Before staring bDMARDs, specific blood tests have to be taken to rule out tuberculosis (TB), Hepatitis B and C, HIV and to check if you have antibodies for the chickenpox/shingles virus.

If you are found to have TB, Hepatitis or HIV, further blood tests may be required. You will have to be seen at the respiratory clinic by the TB nurses if your blood test is positive. They will decide if you need treatment, and they will advise us when you can start your bDMARDs. You may also have to be monitored more closely or take extra medication along with your bDMARDs.

If you have not had chickenpox or shingles and are found to have no antibodies, you will have to have the chickenpox vaccination before you start your treatment. This will be carried out at one of the vaccinations centres.

You may also be asked to have certain vaccinations before starting bDMARDs and this will be carried out at one of the vaccinations centres.

Your chest X-ray is normally updated before your start these medications.

 

 

 

Biosimilars:

A biosimilar medicine is a biological medication manufactured to be similar to an existing originator biological medication whose patent has expired. It has no meaningful differences from the original in terms of quality, safety or efficacy.

 

Targeted Synthetic DMARDs (tsDMARDs)

• JAK Inhibitors:

Baricitinib

Filgotinib

Tofacitinib

Upadacitinib

These are newer treatments for inflammatory arthritis. These treatments are used if you cannot tolerate or have side effects to the csDMARDs or if these medications are not enough to control your inflammatory arthritis. They can be quicker acting than the csDMARDs and the bDMARDs.  They come in tablet form and will be delivered to your home address by a homecare company. Your nurse will inform you which company.

The same pre-treatment tests that are needed for the bDMARDs will be carried out before you start these medications.

 

Useful Links

Versus Arthritis: http://www.versusarthritis.org

National Rheumatoid Arthritis society: https://nras.org.uk

Psoriasis and psoriatic arthritis association: https:// www.papaa.org

National Axial Spondyloarthritis Association: https://nass.co.uk

 

 

 

 

Abatacept

Abatacept works on the inflammatory pathway to modulate T cells activation, thereby reducing the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The brand name is Orencia.

Abatacept can be taken along with other cDMARDs such as methotrexate, or taken on its own (monotherapy).

In rheumatology, Abatacept is licensed for Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Juvenile Idiopathic Arthritis (JIA). The injection is not licensed for JIA patients under the age of 18 years, but the infusion (drip) is.

Delivery

The injections are delivered to your home address by Lloyds Pharmacy Clinical Homecare. They will notify you when your injections are ready to be delivered. Currently, delivery for the first batch of injections is 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. Lloyds have nurses who can come to your home to supervise your first injection. They also deliver and take away the medicine waste bins. Lloyds contact number is 0345 8888 238 and email LPCH.CustomerServiceGlasgow@nhs.net.

Storage

Abatacept injections should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original package to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for 30 minutes before injecting to allow the medicine to come to room temperature.

How do you take Abatacept?

Abatacept can be taken in 2 ways: Subcutaneous (under the skin) injection – a weekly injection of 125mg or by infusion (a drip).

Injection - the injection device is available as a pen or prefilled syringe. These are single use injections and you should take the injection out of the fridge for 30 minutes before injecting to allow the medicine to come to room temperature.

You will be given instruction on how to self-inject by one of the nurses. Further information on injection technique can be found at the following link:

Patient Administration Video Guides | BMS-Optimal

Infusion – the dose is calculated by how much you weigh. Sometimes it is given as a loading dose initially, with infusions at 0 (first infusion), 2 and 4 weeks. It is then given every 4 weeks whilst you remain on the medication. Blood tests are taken when you attend for your infusion, if you are not on blood monitoring for cDMARDs. Your infusion will be given in the day-case unit in the rheumatology department. You need to be well and free from infection when you have your infusion. The infusion takes 30 minutes, but your appointment will be about 1 hour to allow for insertion of the cannula into your vein for the drip and to check your blood pressure, pulse, respiratory rate and temperature etc.

Possible Side effects and cautions of use

There are a few possible side effects that can occur in a small number of people that take Abatacept. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet packaged with your injection.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you become unwell with infection, contact your GP. Is you have an infection and need to take antibiotics, do not take your Abatacept injection until a couple of days after you have finished your course of antibiotics and are feeling well. If you do not feel the antibiotics have helped, please contact your GP or NHS 24 again.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Weekly injections should be stopped 2 weeks before and after surgery. You should wait until at least 4 weeks after your last infusion before having surgery and again wait 2 weeks after before having your next infusion. Wounds should be healing well and free of infection before restarting your treatment.

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Abatacept should be stopped at conception but could be used during pregnancy if you had severe disease and there were no alternatives. If it is used in the 3^rd trimester of pregnancy, avoid giving live vaccinations (Rotovirus, BCG) in infant vaccination schedule until 6 months of age. It can be used during breastfeeding but there is limited data on the safety.

Men can use adalimumab if they are trying to father a child, but there is limited data on the safety.

Vaccinations

• Flu, the pneumonia vaccine and COVID vaccines are safe and recommended whilst taking abatacept.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, BCG (for tuberculosis) and Measles, Mumps and Rubella (MMR) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Abatacept therapy to patients over the age of 50.
• If you take the Abatacept injection, you may want have your vaccinations on a different day to your injection.
• If you receive the Abatacept infusion, it would be best to have your vaccinations in between infusions (2 weeks after the previous infusion).

Travel

When travelling with Abatacept injections, the medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the pen in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey.

 

 

Adalimumab

Adalimumab blocks the Tumour Necrosing Factor (TNF) protein and therefore it is called a TNF inhibitor. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand was called Humira, but now in NHS Grampian we use the Biosimilar, Amgevita.

Adalimumab can be taken along with other cDMARDs such as methotrexate or on its own (monotherapy).

In rheumatology, Adalimumab is licensed for Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), Juvenile Idiopathic Arthritis (JIA) and Axial Spondyloarthritis (AxSpA)

Delivery

The injections are delivered to your home address by Sciensus. They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. Sciensus have nurses who can come to your home to supervise your first injection. They also deliver and take away the medicine waste bins. The contact number for Sciensus is 03331039499.

Storage

Adalimumab should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for at least 30 minutes before injecting to allow the medicine to come to room temperature.

Amgevita and Humira can be left out of the fridge for up to 14 days up to a maximum of 25 degrees centigrade. The injection device should be protected from light and discarded if not used within the 14 day period or it becomes warmer than 25 degrees centigrade.

How do you take Adalimumab?

By subcutaneous (under the skin) injection – an injection of 40mg every 2 weeks.

The injection device is available as a pen device or prefilled syringe. These are single use injections. You will be given instruction on how to self-inject by one of the nurses. Further information on injecting can be found at the following link:

www.amgencare.co.uk/Amgevita

 

Potential side effects

There are a few possible side effects that can occur in a small number of people that take adalimumab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet packaged with your injection.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking adalimumab, you should contact your GP to find out if you need antibiotic therapy. You should stop your adalimumab until you have finished your course of antibiotic therapy, and if well a couple of days later, you can start your adalimumab again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Injections should be stopped 4 weeks before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that adalimumab can be used while trying to conceive, during pregnancy and when breast feeding. If your disease is stable and you stop this medication at 28 weeks of pregnancy, then the full term infant can have their normal childhood vaccination schedule.

Men can use adalimumab if they are trying to father a child.

Vaccinations

• Flu, the pneumonia vaccine and COVID vaccines are safe and recommended whilst taking adalimumab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, BCG (for tuberculosis) and Measles, Mumps and Rubella (MMR) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which is recommended for people over the age of 50 on Adalimumab.
• If you take the adalimumab injection, you may want to have your vaccinations in the middle of your injection cycle to increase your chances of making a good response to the vaccine.

Travel

When travelling with adalimumab injections, if you are going to use the injections within 14 days, and you keep it under 25 degrees centigrade, you do not need to store it in a cool bag, but keep in the original packaging to protect from light. Otherwise the medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey.

 

 

 

 

 

Anakinra

Anakinra blocks the Interleukin 1 (IL1) protein and therefore it is called an IL1 inhibitor. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called Kineret, and there is no biosimilar.

Anakinra can be taken along with other cDMARDs such as methotrexate or on its own (monotherapy).

In adult rheumatology, Anakinra is licensed for Rheumatoid Arthritis (RA), Periodic Fever Syndromes and Adult Still’s disease.

 

Delivery

The injections are delivered to your home address by the homecare company Alcura. They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. They also deliver and take away the medicine waste bins. The contact number for Alcura is 0800280376.

Storage

Anakinra should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for at least 30 minutes before injecting to allow the medicine to come to room temperature.

Anakinra can be left out of the fridge for up to 72 hours up to a maximum temperature of 25 degrees centigrade. The injection device should be protected from light and discarded in the medicine waste bin if not used within the 72 hour period or it is above 25 degrees centigrade.

How do you take Anakinra?

By subcutaneous (under the skin) injection – an injection of 100mg daily.

The injection device is available as a prefilled syringe. These are single use injections. You will be given instruction on how to self-inject by one of the nurses. Further information on injecting can be found at the following link:

https://www.kineretrx.com/ra/using kineret

 

Potential side effects

There are a few possible side effects that can occur in a small number of people that take Anakinra. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet packaged with your injection.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking Anakinra, you should contact your GP to find out if you need antibiotic therapy. You should stop your Anakinra until you have finished your course of antibiotic therapy, and if well a couple of days later, you can start your Anakinra again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Injections should be stopped 1 week before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Anakinra should be stopped when you become pregnant. If there is no alternative for your condition and your disease is severe during pregnancy, you may be able to continue with your injections, but this will be up to your rheumatologist. You can breast feed while taking Anakinra but there is limited data on the safety of use of Anakinra with breastfeeding. If you use Anakinra in the last 3 months of pregnancy, live vaccinations should be avoided in the infant vaccination schedule for the first 6 months (Rota-virus and the BCG vaccine).

Men can use Anakinra if they are trying to father a child, but there is still limited data on the safety of use.

Vaccinations

• Flu, the pneumonia vaccine and COVID vaccines are safe and recommended whilst taking Anakinra.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, BCG (for tuberculosis) and Measles, Mumps and Rubella (MMR) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Anakinra therapy for patients over the age of 50.

Travel

When travelling with Anakinra injections, the medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Anakinra can be left out of the fridge for up to 72 hours up to a maximum temperature of 25 degrees centigrade. The injection device should be protected from light and discarded in the medicine waste bin if not used within the 72 hour period or it is above 25 degrees centigrade. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey.

 

 

 

 

 

 

Certolizumab

Certolizumab binds to a specific protein called Tumour Necrosis Factor (TNF) protein and therefore is called a TNF inhibitor. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called Cimzia and there is no biosimilar.

It can be given along with cDMARDs or on its own (monotherapy).

In rheumatology Certolizumab is licensed for Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Axial Spondyloarthritis (AxSpA). It is not used for anyone under the age of 18 years.

Delivery

The injections are delivered to your home address by Lloyds Pharmacy Clinical Homecare. They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. Lloyds have nurses who can come to your home to supervise your first injection. They also deliver and take away the medicine waste bins. The contact number for Lloyds is 0345 8888 238 and email LPCH.CustomerServiceGlasgow@nhs.net.

Storage

Certolizumab should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for at least 30 to 45 minutes before injecting to allow the medicine to come to room temperature. It can be left out of the fridge for up to 10 days, and you keep it under 25 degrees centigrade. The injection should be discarded if you do not use it within the 10 days out of the fridge or if it becomes warmer than 25 degrees centigrade.

How do you take Certolizumab?

By subcutaneous injection – an injection of 400mg (2 pens or syringes) at week 0 (first injection), week 2 and 4 then 200mg (1 pen or syringe) every 2 weeks.

The injection device is available as a pen or prefilled syringe. These are single use injections and they should be stored in the fridge at home. You will be given instruction on how to self-inject by one of the nurses.

Further information on injecting can be found at the following links:

https://vimeo.com/257898865/cc6b36e560 - Pen device

https://vimeo.com/257899094/2878abed8f - Pre-filled syringe

Possible side effects

There are a few possible side effects that can occur in a small number of people that take Certolizumab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet packaged with your injection.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking Certolizumab, you should contact your GP to find out if you need antibiotic therapy. You should stop your Certolizumab until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your injections again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Injections should be stopped 4 weeks before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Certolizumumab can be used while trying to conceive, during pregnancy and during breast feeding. A full term infant can have their normal childhood vaccination schedule.

We recommend that you stop your Certolizumab injections 4 weeks before your due date in case you need a cesarean section, to reduce your risk of infection.

Men can use Certolizumab if they are trying to father a child.

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Certolizumab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Certolizumab therapy in people over the age of 50.

Travel

When travelling with certolizumab injections, if you are going to use the injections within 10 days, and you keep it under 25 degrees centigrade, you do not need to store it in a cool bag, but keep in the original packaging to protect from light. The injection should be discarded if you do not use it within the 10 days out of the fridge. Otherwise the medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey.

 

 

 

 

 

 

 

Etanercept

Etanercept blocks the activity of the Tumour Necrosis Factor (TNF) protein and is called a TNF inhibitor. It reduces the inflammation you get with arthritis and reduces the symptoms such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand was called Enbrel, but now in NHS Grampian we use the Biosimilar, Benepali.

It can be given along with cDMARDs such as methotrexate or on its own (monotherapy).

In rheumatology Etanercept is licensed for Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Axial Spondyloarthritis (AxSpA).

Benepali and Enbrel can be used for inflammatory diseases in children and adolescents under the age of 18 years. The dose will then be determined by age and condition.

Delivery

The injections are delivered to your home address by Sciensus. They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. Sciensus have nurses who can come to your home to supervise your first injection. They also deliver and take away the medicine waste bins. The contact number for Sciensus is 03331039499.

Storage

Etanercept should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for at least 30 minutes before injecting to allow the medicine to come to room temperature.

Benepali and Enbrel can be left out of the fridge for up to 28 days up to a maximum of 25 degrees centigrade. The injection device should be protected from light and discarded if not used within the 28 day period.

 

 

 

How do you take Etanercept?

By subcutaneous (under the skin) injection – an injection of 50mg every week (or sometimes 25mg twice weekly).

The injection device is available as a pen or prefilled syringe. You should take the injection out of the fridge for at least 30 minutes before you inject. Benepali is clear, opalescent to pale yellow and Enbrel is clear, colourless to pale yellow. You will be given instruction on how to self-inject by one of the nurses. This medication will be delivered to you by a company called Sciensus, and they have nursing staff who can come to your home to supervise your 1^st injection.

Further information on injection technique can be found at the following link:

care.benepali.eu/en

Possible side effects

There are a few possible side effects that can occur in a small number of people that take Etanercept. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet packaged with your injection.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking Etanercept, you should contact your GP to find out if you need antibiotic therapy. You should stop your Etanercept until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your injections again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

 

 

Operations

Injections should be stopped 2 weeks before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Etanercept can be used while trying to conceive, during pregnancy and during breast feeding. If you have a low risk of disease flare and stop Etanercept by 32 weeks of pregnancy, a full term infant can have their normal childhood vaccination schedule.

We recommend that you stop your Etanercept injections 4 weeks before your due date in case you need a cesarean section, to reduce your risk of infection.

Men can use Etanercept if they are trying to father a child.

Vaccinations

• The flu, pneumonia COVID vaccines are safe and recommended whilst taking Etanercept.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and the BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Etanercept therapy to people over the age of 50.

Travel

When travelling with Etanercept injections, if you are going to use the injections within 28 days, and you keep them under 25 degrees centigrade, you do not need to store it in a cool bag, but keep in the original packaging to protect from light. The injection should be discarded if you do not use it within 28 days out of the fridge. Otherwise the medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Golimumab

Golimumab blocks the Tumour Necrosis Factor (TNF) protein and is called a TNF inhibitor. It reduces the inflammation you get from arthritis and helps with symptoms such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called Simponi and there is no biosimilar.

It can be given along with cDMARDs such as methotrexate or on its own (monotherapy).

In rheumatology Golimumab is licensed for Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Axial Spondyloarthritis (AxSpA).

Golimumab is used for the treatment of polyarticular juvenile idiopathic arthritis in children aged 2 years and older.

Delivery

The injections are delivered to your home address by Sciensus. They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. There is no nurse supervision available from Sciensus with this medication. The rheumatology department can arrange for you to have your first Golimumab injection supervised in the clinic. If you live out with Aberdeen, your practice nurse may supervise your first injection but we would need to ask permission first. Sciensus also deliver and take away the medicine waste bins. The contact number for Sciensus is   03331039499.

Storage

Golimumab should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for at least 30 minutes before injecting to allow the medicine to come to room temperature.

Golimumab can be left out of the fridge for up to 30 days up to a maximum of 25 degrees centigrade if it is still within the use by (expiry) date. The injection device should be protected from light and discarded if not used within the 30 day period. Do not return to the fridge if it has reached room temperature.

How do you take Golimumab?

By subcutaneous (under the skin) injection – an injection of 50mg once a month, on the same date each month. If you weigh more than 100kg your dose may be increased to 100mg (2 injections) given once a month, on the same date each month.

The injection device is available as a pen or prefilled syringe. These are single use injections. You should take it out of the fridge 30 minutes before injecting to allow it to come to room temperature. You will be given instruction on how to self-inject by one of the nurses.

Further information on injection can be found at the following link:

How to Inject SIMPONI® (golimumab)

Possible side effects

There are some restrictions on the use of Golimumab and a few possible side effects that can occur in a small number of people that take Golimumab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

You will also find information on the product patient information leaflet.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking Golimumab, you should contact your GP to find out if you need antibiotic therapy. You should stop your Golimumab until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your injections again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Golimumab injections should be stopped 4 weeks before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

 

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Golimumab can be used while trying to conceive, during pregnancy and during breast feeding. If you have a low risk of disease flare and stop Golimumab by 28 weeks of pregnancy, a full term infant can have their normal childhood vaccination schedule.

We recommend that you stop your Golimumab injections 4 weeks before your due date in case you need a cesarean section, to reduce your risk of infection.

Men can take Golimumab when trying to father a child.

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Golimumab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Golimumab therapy to people over 50 years of age.

Travel

When travelling with Golimumab injections, if you are going to use the injections within 30 days, and you keep them under 25 degrees centigrade, you do not need to store it in a cool bag, but keep in the original packaging to protect from light. The injection should be discarded if you do not use it within 30 days out of the fridge. Otherwise the medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey.

 

Guselkumab

Guselkumab blocks the activity of a protein called Interleukin 23 (IL23) which is present at increased levels in people with inflammatory arthritis. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called Tremfya and there is no biosimilar.

In Rheumatology, Guselkumab is licensed for Psoriatic Arthritis (PsA). It is not recommended for children and adolescents under 18 years of age as it has not been studied in this group.

Delivery

The injections are delivered to your home address by Lloyds Pharmacy Clinical Homecare (LPCH). They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment.  LPCH can provide a nurse who will come to your home to supervise your first injection. LPCH also deliver and take away the medicine waste bins. The contact number for Lloyds is 0345 8888 238 and email is LPCH.CustomerServiceGlasgow@nhs.net.

Storage

Guselkumab should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for at least 30 minutes before injecting to allow the medicine to come to room temperature.

How do you take Guselkumab?

By subcutaneous (under the skin) injection – an injection of 100mg, initially at week 0 (first injection), week 4 the every 8 weeks. For patients at high risk for joint damage, according to your consultant’s judgement, a dose of 100mg every 4 weeks may be considered.

It is a clear, colourless to light yellow solution. The injection device is available as a prefilled pen or prefilled syringe. These are single use injections and you will be given instruction on how to self-inject by one of the nurses.

 

Currently no link is available for viewing the injection technique, but there is instructions on injecting with the patient information leaflet.

 

Possible side effects

There are some restrictions on the use of Guselkumaab and a few possible side effects that can occur in a small number of people that take Guselkumab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There is also information in the patient information leaflet that comes with the medication.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking Guselkumab, you should contact your GP to find out if you need antibiotic therapy. You should stop your Guselkumab until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your injections again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Guselkumab injections should be stopped 8 weeks before and could be restarted 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

Before and during pregnancy and breastfeeding

Guselkumab is a fairly new treatment for Psoriatic Arthritis and the effects of this medication on pregnant women and unborn babies are unknown. Women should use a reliable form of contraception for at least 12 weeks after their last injection before trying to conceive. It should not be used during pregnancy or breastfeeding, and you should let your rheumatologist know if you are planning pregnancy and you may be offered an alternative medication.

There is no data on the use of Guselkumab in men trying to father a child and you may be offered an alternative medication.

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Guselkumab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Guselkumab therapy for people over the age of 50.

Travel

When travelling with Guselkumab injections, you need to store it in a cool bag. The medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey.

 

 

 

 

 

 

 

 

Infliximab

Infliximab is a blocks the Tumour Necrosis Factor (TNF) protein and therefore it is called a THF inhibitor. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints.

The originator brand is called Remicade, but in NHS Grampian we now use the biosimilar, Remsima.

It should be used in combination with methotrexate.

In Rheumatology Infliximab is licensed for Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), Juvenile Idiopathic Arthritis (JIA) and Axial Spondyloarthritis (AxSpA).

How do you take Infliximab?

By IV infusion (a drip):

You will receive an initial loading dose at week 0 (first infusion), 2 weeks later, then another 4 weeks later, then every 8 weeks. Some patientsmay have the infusion more frequently than every 8 weeks.

Patients with RA or JIA receive a dose of 3mg/kg body weight in a 250ml bag of saline over 1 to 2 hours.

Patients with PsA or AxSpA receive a dose of 5mg/kg body weight in a 250ml bag of saline over 1 – 2 hours.

We ask patients to stay in the rheumatology for 2 hours after their first 3 infusions to monitor for a delayed reaction to Infliximab. This is then reduced to 1 hours for a further 2 – 3 infusions and if no problems following this, the patient can go home after the infusion is finished.

By subcutaneous (under the skin) injection (for RA) – an injection of 120mg. You will have an initial loading dose which can be via infusion of injection.

Infusion loading dose – 2 infusions at a dose of 3mg/kg body weight in a 250ml bag of saline over 1 to 2 hours 2 weeks apart, then an injection 4 weeks later and then every 2 weeks.

Injection loading dose – week 0 (first injection) then at weeks 1, 2, 3 and 4 and then every 2 weeks thereafter.

 

 

The injection device is available as a pen or prefilled syringe. These are single use injections.

You will be given instruction on how to self-inject by one of the nurses. Further information on injecting can be found at the following link:

https://md-education.wistia.com/medias/2dlllucxdx

Delivery

The injections are delivered to your home address by Lloyds Pharmacy Clinical Homecare (LPCH). They will notify you when your injections are ready to be delivered. Currently, delivery for the first batch of injections is 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. LPCH have nurses who can come to your home to supervise your first injection. They also deliver and take away the medicine waste bins. LPCH contact number is 0345 8888 238 and email is PCH.CustomerServiceGlasgow@nhs.net.

Storage

Infliximab injections should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original package to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for 30 minutes before injecting to allow the medicine to come to room temperature.

They can be stored out of the fridge in the original packaging for up to 28 days at a temperature of less than 25 degrees centigrade. It should be protected from light and discarded into the medicine waste bin if not used within the 28 days or becomes warmer than 25 degrees.  

Possible side effects

There are some restrictions on the use of Infliximab and a few possible side effects that can occur in a small number of people that take Infliximab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet packaged with your injection.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking Infliximab or due your infusion, you should contact your GP to find out if you need antibiotic therapy. You should stop your Infliximab injections until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your Infliximab again. Your infusion will be delayed if you have an infection. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Planned surgery should take place 6 – 8 weeks after your last Infliximab infusion, depending on the frequency of your infusion. Infliximab injections should be stopped 4 weeks before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Infliximab can be used while trying to conceive, during pregnancy and during breast feeding. If there is a low risk of your disease flaring and infliximab is stopped at 20 weeks of pregnancy, a full term infant can have their normal childhood vaccination schedule. If it is taken for longer please seek advice from the rheumatology team.

We recommend that you stop your infliximab injections 4 weeks before your due date and have your last infusion 8 weeks before your due date in case you need a cesarean section, to reduce your risk of infection.

Infliximab is safe to use trying to father a child.

 

 

 

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Infliximab
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Infliximab therapy for people over 50 years of age.

 

Travel

When travelling with Infliximab injections, they can be stored out of the fridge in the original packaging for up to 28 days at a temperature of less than 25 degrees centigrade. It should be protected from light and discarded into the medicine waste bin if not used within the 28 days or becomes warmer than 25 degrees.  

If you want to keep it cool you need to store it in a cool bag. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey.

 

 

 

 

 

 

 

Ixekizumab

Ixekizumab blocks the Interleukin 17A protein and therefore it is an IL17A inhibitor. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called Taltz and there is no biosimilar. In rheumatology it is licensed for Psoriatic Arthritis and Axial Spondyloarthritis.

Delivery

The injections are delivered to your home address by Lloyds Pharmacy Clinical Homecare (LPCH). They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment.  LPCH can provide a nurse who will come to your home to supervise your first injection. LPCH also deliver and take away the medicine waste bins. The contact number for Lloyds is 0345 8888 238 and email is LPCH.CustomerServiceGlasgow@nhs.net.

Storage

Ixekizumab should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for at least 30 minutes before injecting to allow the medicine to come to room temperature. Ixekizumab can be left out of the fridge for up to 5 days at a temperature not above 30 ºC. The injection should be protected from light and discarded if not used within the 5 days.

 

How do you take Ixekizumab?

By subcutaneous injection – Initially a first dose of 160mg (two 80mg injections) followed by an 80mg injection every 4 weeks.  

The injection device is available as a pen or prefilled syringe. These are single use injections and they should be stored in the fridge at home between 2 and 8 degrees centigrade. You will be given instruction on how to self-inject by one of the nurses. Further information on injection can be found at the following link:

https://www.taltz.com/taking-taltz

Possible side effects

There are some restrictions on the use of Ixekizumab and a few possible side effects that can occur in a small number of people that take Ixekizumab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet packaged with your injection.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

 

Illness

If you have an infection when you are taking Ixekizumab, you should contact your GP to find out if you need antibiotic therapy. You should miss your Ixekizumab injection if it is due when you are taking antibiotics  until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your injections again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Ixekizumab injections should be stopped 4 weeks before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Ixekizumab should be stopped once you are pregnant. You may be offered an alternative medication, but if there are none suitable alternatives and your disease is severe, it can be used during pregnancy. If it is used in the last 3 months of pregnancy, live vaccinations should be avoided in the infant vaccination schedule for 6 months. (This is usually the rota virus and BCG vaccination). There is limited data on the safety of Ixekizumab when taken during breast feeding.

There is limited data on the use of Ixekizumab in men trying to father a child. You may be offered an alternative medication which is compatible with pregnancy.

 

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Ixekizumab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Ixekizumab therapy.(for over 50s).

Travel

When travelling with Ixekizumab injections, you need to store it in a cool bag. The medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. It can be kept out of the fridge for up to 5 days at less than 30 degrees centigrade. If it becomes warmer than this or is out for more than 5 days it must be disposed of in the medicine waste bin. You cannot use it if you cool it down again. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey.

 

 

 

 

 

 

 

Rituximab

Rituximab is a monoclonal antibody which binds to the surface of a type of white blood cell called a B-Lymphocyte with a marker called CD20. When rituximab sticks to this marker on the B-Lymphocye, the cells dies. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called Mabthera and the biosimilar is called Truxima.

How do you take Rituximab?

Rituximab is given by an intravenous infusion (drip). Each treatment is made up of 2 separate infusions 2 weeks apart. The infusions can’t be given again for a further 6 months. After 2 – 3 treatments, the interval between infusions might be increased to every 9 or 12 months.

Each time you have an infusion, you will be given some steroid via the drip, an antihistamine injected into the cannula that is put into your vein for the drip, and paracetamol tablets. This medication is given to help to prevent you experiencing any side effects of the Rituximab during the infusion. We ask that you do not take any paracetamol containing products or antihistamines the morning of your infusions. We may also ask you to omit your blood pressure medication on the morning of your infusion, but that will be on an individual patient decision.

Possible side effects

There are some restrictions on the use of Rituximab and a few possible side effects that can occur in a small number of people that take Rituximab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

You can ask for the patient information leaflet from the packaging when you attend for your infusion.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

 

Illness

If you have an infection (including COVID) prior to your Rituximab infusion we will have to postpone your infusion until the infection has been treated. If you think you have an infection, you should contact your GP to find out if you need antibiotic therapy. If you find you are having more frequent infections than normal after your infusions, inform the rheumatology department.

 

Operations

Operations should be carried out between 2 – 4 months before or after Rituximab infusions depending on the infection risk of the surgery. The timing will be determined by your Rheumatologist and Surgeon.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Rituximab should be stopped at conception. If your disease is severe, and there are no suitable alternatives, Rituximab could be administered during pregnancy. It can be given during breast feeding but there is limited evidence for safety. A full term infant can have their normal childhood vaccination schedule.

There is limited data on the use of Rituximab in men trying to father a child, but the guidelines say it can be used.

 

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Rituximab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Rituximab therapy.(For over 50s).
• If you are due to have your Rituximab infusion around the time of the yearly flu (and covid) vaccinations, we would advise having the vaccinations 4 weeks before your Rituximab infusion, or if this is not possible, 4 – 8 weeks after your infusion.

 

Sarilumab

Sarilumab blocks the Interleukin 6 (IL6) protein and therefore it is an IL6 inhibitor. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called KevZara and there is no biosimilar.

Sarilumab can be taken along with other cDMARDs such as methotrexate or on its own (monotherapy).

In rheumatology, Sarilumab is licensed for Rheumatoid Arthritis (RA).

Delivery

The injections are delivered to your home address by Healthnet Homecare. They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment.  Healthnet do not provide nursing supervision with your first injection. Healthnet also deliver and take away the medicine waste bins. The contact number for Healthnet is 0800 083 3060.

Storage

Sarliumab should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for at least 30 minutes before injecting to allow the medicine to come to room temperature.

How do you take Sarilumab?

By subcutaneous injection (under the skin) – an injection of 200mg or 150mg every 2 weeks.

The injection device is available as a pen or prefilled syringe. These are single use injections and they should be stored in the fridge at home between 2 and 8 degrees centigrade. It can be stored out of the fridge for up to 14 days, but keep it in its original packaging. If not used within this time or it is over 25 degrees centigrade, then it must be disposed of in the medicines waste bin. You will be given instruction on how to self-inject by one of the nurses. Further information on injection can be found at the following link:

How to Inject KEVZARA® (sarilumab)

Possible side effects

There are some restrictions on the use of Sarilumab and a few possible side effects that can occur in a small number of people that take Sarilumab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There is also information in the patient information leaflet that comes with the medication.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking Sarilumab, you should contact your GP to find out if you need antibiotic therapy. You should stop your Sarilumab until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your injections again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Sarilumab injections should be stopped 4 weeks before and could be restarted 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Sarilumab should be stopped once you are pregnant. You may be offered an alternative medication, but if there are none suitable alternatives and your disease is severe, it can be used during pregnancy. If it is used in the last 3 months of pregnancy, live vaccinations should be avoided in the infant vaccination schedule for 6 months. (This is usually the rota virus and BCG vaccination). There is limited data on the safety of Sarilumab when taken during breast feeding.

There is limited data on the use of Sarilumab in men trying to father a child. You may be offered an alternative medication which is compatible with pregnancy.

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Sarilumab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Sarilumab therapy.(For over 70s).

Travel

When travelling with Sarilumab injections, you need to store it in a cool bag. The medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey. Sarilumab can be out of the fridge for up to 2 weeks if it is kept at a temperature of less than 25 degrees centigrade. If it is warmer than this or more than 2 weeks since it was removed from the fridge, the pen/syringe should be disposed of.

 

 

 

 

 

 

Secukinumab

Secukinumab blocks the Interleukin 17A (IL17A) protein and therefore it is an IL17A inhibitor. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called Cosentyx and there is no biosimilar. In Rheumatology it is licensed for Psoriatic Arthritis and Axial Spondyloarthritis in the following doses:

If it is your first biologic injection forPsoriatic Arthritis: 150mg

If it is not your first injection for Psoriatic Arthritis: 300mg

If it is your first injection for Psoriatic Arthritis and you have bad Psoriasis: 300mg

If it is not your first injection for Axial Spondyloarthritis:150mg

If 150mg is not enough for your Axial Spondyloarthritis: the dose might be increased to 300mg

 

Delivery

The injections are delivered to your home address by Lloyds Pharmacy Clinical Homecare (LPCH). They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment.  LPCH have nurses who can come to your home to supervise your first injection. They also deliver and take away the medicine waste bins. LPCH contact number is 0345 8888 238 and email is PCH.CustomerServiceGlasgow@nhs.net.

Storage

Secukinumab should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for at least 30 minutes before injecting to allow the medicine to come to room temperature. It can be out of the fridge for up to 4 days if it is kept at a temperature of less than 30 degrees centigrade. If it is warmer than this or more than 4 days since it was removed from the fridge, the pen/syringe should be disposed of in your medicines waste bin.

How do you take Secukinumab?

By subcutaneous injection – an injection of 150mg or 300mg every month. Initially you will have a loading dose of either 150 or 300mg – an injection weekly for the first 5 injections and then you inject once a month.

The injection device is available as a pen or prefilled syringe. These are single use injections. You will be given instruction on how to self-inject by one of the nurses. Further information on injection can be found at the following link:

https://www.hcp.novartis.co.uk/cosentyx-admin-patient/

Possible side effects

There are some restrictions on the use of Secukinumab and a few possible side effects that can occur in a small number of people that take Secukinumab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet packaged with your injection.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

 

Illness

If you have an infection when you are taking Secukinumab, you should contact your GP to find out if you need antibiotic therapy. If you need to take antibiotics and your injection is due, delay it until you have finished your antibiotics, and if well a couple of days later you can start your injections again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

 

 

 

Operations

Secukinumab injections should be stopped 4 weeks before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Secukinumab can be used up until you become pregnant. You may be offered an alternative medication, but if there are none suitable alternatives and your disease is severe, it can be used during pregnancy. If it is used in the last 3 months of pregnancy, live vaccinations should be avoided in the infant vaccination schedule for 6 months. (This is usually the rota virus and BCG vaccination). There is limited data on the safety of Secukinumab when taken during breast feeding.

There is limited data on the use of Secukinumab in men trying to father a child. You may be offered an alternative medication which is compatible with pregnancy.

 

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Secukinumab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Secukinumab therapy.(for over 50s).

 

 

 

Travel

When travelling with Secukinumab injections, you need to store it in a cool bag. The medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey. It can be out of the fridge for up to 4 days if it is kept at a temperature of less than 30 degrees centigrade. If it is warmer than this or more than 4 days since it was removed from the fridge, the pen/syringe should be disposed of in your medicines waste bin.

 

 

 

 

 

 

 

 

 

 

 

 

 

Tocilizumab

Tocilizumab blocks the Interleukin 6 (IL6) protein and therefore it is an IL6 inhibitor. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called Roactemra and there is no biosimilar.

In Rheumatology it is licensed for Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA) and Giant Cell Arteritis (GCA – injection only).

Delivery

The injections are delivered to your home address by Lloyds Pharmacy Clinical Homecare (LPCH). They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment.  LPCH have nurses who can come to your home to supervise your first injection. They also deliver and take away the medicine waste bins. LPCH contact number is 0345 8888 238 and email is PCH.CustomerServiceGlasgow@nhs.net.

Storage

Tocilizumab should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. You should take the injection out of the fridge for 45 minutes before injecting to allow the medicine to come to room temperature. Once removed from the fridge the injection can be stored for up to 2 weeks at less than 30 degrees centigrade. After 2 weeks or if the temperature is greater than 30 degrees, the pen should be disposed of in the medicine waste bin.

How do you take Tocilizumab?

By subcutaneous (under the skin) injection – an injection of 162mg every week. The injection device is available as a pen or prefilled syringe. These are single use injections. You will be given instruction on how to self-inject by one of the nurses. Further information on injection can be found at the following link:

 

Subcutaneous Injections for RA | ACTEMRA® (tocilizumab)

 

Infusion – the dose is calculated by how much you weigh – 8mg per kg body weight. It is given every 4 weeks whilst you remain on the medication. Blood tests are taken when you attend for your infusion, if you are not on blood monitoring for cDMARDs. Your infusion will be given in the day-case unit in the rheumatology department. You need to be well and free from infection when you have your infusion. The infusion takes 60 minutes, but your appointment will be about 1and a half hours to allow for insertion of the cannula into your vein for the drip and to check your blood pressure, pulse, respiratory rate and temperature etc.

 

Possible side effects

There are some restrictions on the use of Tocilizumab and a few possible side effects that can occur in a small number of people that take Tocilizumab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet packaged with your injection.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking Tocilizumab, you should contact your GP to find out if you need antibiotic therapy. You should stop your Tocilizumab until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your injections again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Tocilizumab injections should be stopped 4 weeks before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids (2022), recommend that Tocilizumab should be stopped once you are pregnant. You may be offered an alternative medication, but if there are none suitable alternatives and your disease is severe, it can be used during pregnancy. If it is used in the last 3 months of pregnancy, live vaccinations should be avoided in the infant vaccination schedule for 6 months. (This is usually the rota virus and BCG vaccination). There is limited data on the safety of Tocilizumab when taken during breast feeding.

There is limited data on the use of Tocilizumab in men trying to father a child. You may be offered an alternative medication which is compatible with pregnancy.

 

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Tocilizumab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Tocilizumab therapy.(For over 50s).

Travel

When travelling with Tocilizumab injections, you need to store it in a cool bag. The medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey. It can be out of the fridge for up to 2 weeks if it is kept at a temperature of less than 30 degrees centigrade. If it is warmer than this or more than 2 weeks since it was removed from the fridge, the pen/syringe should be disposed of in your medicine waste bin.

Ustekinumab

Ustekinumab blocks the Interleukin 12 and 23 proteins (IL12 and 23) and it is an IL12 and 23 inhibitor. It reduces the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints. The originator brand is called Stelara and there is no biosimilar. In Rheumatology it is licensed for Psoriatic Arthritis (PsA).

Delivery

The injections are delivered to your home address by Lloyds Pharmacy Clinical Homecare (LPCH). They will notify you when your injections are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of injections is taking 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment.  LPCH have nurses who can come to your home to supervise your first injection. They also deliver and take away the medicine waste bins. LPCH contact number is 0345 8888 238 and email is LPCH.CustomerServiceGlasgow@nhs.net.

 

Storage

Ustekinumab should be stored in the fridge between 2 – 8 degrees centigrade. Do not freeze. Store in the original packaging to protect from light and do not store at the back of the fridge in case the packaging sticks and freezes. Once removed from the fridge the injection can be stored for up to 30 days at less than 30 degrees centigrade. After 30 days or if the temperature is greater than 30 degrees, the pen should be disposed of in the medicine waste bin.

 

How do you take Ustekinumab?

By subcutaneous (under the skin) injection – an injection of 45mg every month is the recommended starting dose. Patients who weigh more than 100kgs may start on a dose of 90mgs.

The injection device is available as a pen or prefilled syringe. Remove from the fridge 30 minutes before you inject to let the pen/syringe come to room temperature. You will be given instruction on how to self-inject by one of the nurses. Further information on injecting can be found on the patient information leaflet.

Side effects

There are some restrictions on the use of Ustekinumab and a few possible side effects that can occur in a small number of people that take Ustekinumab. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

 

Illness

If you have an infection when you are taking Ustekinumab, you should contact your GP to find out if you need antibiotic therapy. You should stop your Ustekinumab until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your injections again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Ustekinumab injections should be stopped 12 weeks before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your injections.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids, recommend that Ustekinumab can be used up to conception. It can be used during pregnancy if your disease is sever and there is no alternative. If it is used in the last 3 months of pregnancy, lives vaccines should be avoided in the infant vaccination schedule until 6 months of age. It can be used during breast feeding, but there is limited safety evidence.

There is limited evidence on the use of Ustekinumab in men trying to father a child.

 

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Ustekinumab.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Ustekinumab therapy.(for over 50s).

Travel

When travelling with Ustekinumab njections, you need to store it in a cool bag. The medication needs to be kept cool. Carry it in a cool bag with ice packs or bags of ice. Do not let the injection pen/syringe touch the ice – try wrapping the injection in bubble wrap. If going on a long flight, take extra re-sealable plastic bags to top up with ice. Always carry as hand luggage and you will need a travel letter to get through airport security.  This can be requested via the rheumatology department, but allow sufficient time before your journey. It can be out of the fridge for up to 30 days if it is kept at a temperature of less than 30 degrees centigrade. If it is warmer than this or more than 30 days since it was removed from the fridge, the pen/syringe should be disposed of in your medicine waste bin.

 

 

 

 

 

 

 

 

 

 

Targeted Synthetic DMARDs (tsDMARDs)

JAK Inhibitors:

Baricitinib

Filgotinib

Tofacitinib

Upadacitinib

These are newer treatments for inflammatory arthritis. These treatments are used if you cannot tolerate or have side effects to the csDMARDs or if these medications are not enough to control your inflammatory arthritis. They can be quicker acting than the csDMARDs and the bDMARDs.  They come in tablet form.

Before staring these medications specific blood tests have to be taken to rule out tuberculosis (TB), Hepatitis B and C, HIV and to check if you have antibodies for the chickenpox/shingles virus.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Baricitinib

 

Baricitinib reduces the activity of an enzyme in the body called ‘Janus Kinase’ (JAK) which is involved in inflammation. It is a JAK inhibitor and reduces the inflammation caused by inflammatory arthritis to help stop joint damage and disease progression. In rheumatology it is used for Rheumatoid Arthritis.

How do you take Baricitinib?

It is a daily tablet of either 2 or 4mg. The 2mg dose is used if you are over 65 years of age, have an increased risk of infections, blood clots, major cardiac events or cancer. If you have reduced kidney function, the recommended dose is also 2mg. The tablet should be swallowed whole with a drink of water. It should not be crushed or dissolved in water.

Delivery

The tablets are delivered to you by the homecare company Lloyds Pharmacy Clinical Homecare. They will notify you when your tablets are ready to be delivered. This may appear as an unknown or withheld nimber on your phone. Currently, delivery for the first batch of tablets is 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. LPCH contact number is 0345 8888 238 and email is LPCH.CustomerServiceGlasgow@nhs.net

 

Possible side effects

There are some restrictions on the use of Baricitinib and a few possible side effects that can occur in a small number of people that take Baricitinib. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

 

Illness

If you have an infection when you are taking Baricitinib, you should contact your GP to find out if you need antibiotic therapy. You should stop your Baricitinib until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your tablets again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Baricitinib tablets should be stopped 1 week before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your tablets.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guidelines on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids, recommend that Baricitinib should be stopped at least 2 weeks before trying to conceive. It cannot be used during breast feeding.

There is limited evidence on the use of Baricitinib in men trying to father a child so it is not recommended.

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Baricitinib.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Baricitinib therapy.(for over 50s).

 

 

 

 

 

Filgotinib

 

Filgotinib reduces the activity of an enzyme in the body called ‘Janus Kinase’ (JAK) which is involved in inflammation. It is a JAK inhibitor and reduces the inflammation caused by inflammatory arthritis to help stop joint damage and disease progression. The brand name is Jyseleca. In rheumatology it is used for Rheumatoid Arthritis.

How do you take Filgotinib?

It is a daily tablet of either 100 or 200mg. The 100mg dose is used if you are over 65 years of age or have reduced kidney function. If you have sever liver disease Filgotinib is not recommended. The tablet should be swallowed whole with a drink of water, with or without food. It should not be crushed or dissolved in water as this can change how much of the medicine gets into your body.

Delivery

The tablets are delivered to you by the homecare company Alcura. They will notify you when your tablets are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of tablets is 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. The contact number for Alcura is 0800280376.

Possible side effects

There are some restrictions on the use of Filgotinib and a few possible side effects that can occur in a small number of people that take Filgotinib. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet with your medication.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

 

 

 

Illness

If you have an infection when you are taking Filgotinib, you should contact your GP to find out if you need antibiotic therapy. You should stop your Filgotinib until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your tablets again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Filgotinib tablets should be stopped 1 week before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your tablets.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guidelines on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids, recommend that Filgotinib should be stopped at least 2 weeks before trying to conceive. Reliable contraception must be used while you are taking Filgotinib and for at least 2 weeks after your last dose. It cannot be used during breast feeding as it is unknown if Filgotinib passes into human breast milk..

There is limited evidence on the use of Filgotinib in men trying to father a child so it is not recommended.

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Filgotinib.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Filgotinib therapy.(for over 50s).

 

Tofacitinib

 

Tofacitinib reduces the activity of an enzyme in the body called ‘Janus Kinase’ (JAK) which is involved in inflammation. It is a JAK inhibitor and can help to reduce pain, stiffness and swelling in your joints, educe tiredness and slow down damage to the bone and cartilage in your joints These effects can ease your daily activities and so improve your quality of life. The brand name is Xeljanz. In rheumatology it is used for Rheumatoid Arthritis, Psoriatic Arthritis, Axial Spondyloarthritis and Juvenile Idiopathic Arthritis.

How do you take Tofacitinib?

It is a twice daily tablet of 5mg. The tablet should be swallowed whole with a drink of water, with or without food. It should not be split, crushed, chewed or dissolved in water as this can change how much of the medicine gets into your body.

Delivery

The tablets are delivered to you by the homecare company Alcura. They will notify you when your tablets are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of tablets is 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. The contact number for Alcura is 0800 280 376.

Possible side effects

There are some restrictions on the use of Tofacitinib, restrictions of some medicines that can be used when on Tofacitinib and a few possible side effects that can occur in a small number of people that take Tofacitinib. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet with your medication.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

 

Illness

If you have an infection when you are taking Tofacitinib, you should contact your GP to find out if you need antibiotic therapy. You should stop your Tofacitinib until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your tablets again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your tablet until 2 weeks after the start of symptoms and you are feeling better.

Operations

Tofacitinib tablets should be stopped 1 week before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your tablets.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guidelines on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids, recommend that Tofacitinib should be stopped at least 4 weeks before trying to conceive. Reliable contraception must be used while you are taking Tofacitinib and for at least 4 weeks after your last dose. It cannot be used during breast feeding as it is unknown if Tofacitinib passes into human breast milk.

There is limited evidence on the use of Tofacitinib in men trying to father a child so it is not recommended.

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Tofacitinib.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Tofacitinib therapy.(for over 50s).

 

Upadacitinib

 

Upadacitinib reduces the activity of an enzyme in the body called ‘Janus Kinase’ (JAK) which is involved in inflammation. It is a JAK inhibitor and can help to reduce pain, stiffness and swelling in your joints, educe tiredness and slow down damage to the bone and cartilage in your joints These effects can ease your daily activities and so improve your quality of life. The brand name is Rinvoq. In rheumatology it is used for Rheumatoid Arthritis, Psoriatic Arthritis and Axial Spondyloarthritis.

How do you take Upadacitinib?

It is a daily tablet of 15mg modified release. The tablet should be swallowed whole with a drink of water, with or without food. It should not be split, crushed, chewed or dissolved in water as this can change how much of the medicine gets into your body. AVOID any food or drink containing grapefruit during treatment with RINVOQ as these may increase the risk of side-effects by increasing the amount of Upadacitinib in your body.      

Delivery

The tablets are delivered to you by the homecare company Sciensus. They will notify you when your tablets are ready to be delivered. This may appear as an unknown or withheld number on your phone. Currently, delivery for the first batch of tablets is 3 – 4 weeks. Subsequent deliveries will be arranged so you should have no gaps in your treatment. The contact number for Sciensus is 0333 103 9499.

Possible side effects

There are some restrictions on the use of Upadacitinib, restrictions of some medicines that can be used when on Upadacitinib and a few possible side effects that can occur in a small number of people that take Upadacitinib. Further details on these can be found at: 

Versus Arthritis: http://www.versusarthritis.org

There will also be a patient information leaflet with your medication.

If you have any side effects that need medical attention please contact your GP surgery or NHS 24 on 111. Please inform the rheumatology department as well as we will need to assess your treatment.

Illness

If you have an infection when you are taking Upadacitinib, you should contact your GP to find out if you need antibiotic therapy. You should stop your Upadacitinib until you have finished your course of antibiotic therapy, and if well a couple of days later you can start your tablets again. If you find you are having more frequent infections than normal, inform the rheumatology department.

If you have COVID don’t take your injection until 2 weeks after the start of symptoms and you are feeling better.

Operations

Upadacitinib tablets should be stopped 1 week before and 2 weeks after surgery. Wounds should be healing well and free of infection before restarting. Sometimes your surgeon will ask you to wait until you have your surgical follow-up before restarting your tablets.

 

Before and during pregnancy and breastfeeding

The British Society for Rheumatology guidelines on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids, recommend that Upadacitinib should be stopped at least 4 weeks before trying to conceive. Reliable contraception must be used while you are taking Upadacitinib and for at least 4 weeks after your last dose. It cannot be used during breast feeding as it is unknown if Upadacitinib passes into human breast milk.

There is limited evidence on the use of Upadacitinib in men trying to father a child so it is not recommended.

Vaccinations

• The flu, pneumonia and COVID vaccines are safe and recommended whilst taking Upadacitinib.
• Live vaccines including the shingles vaccine (Zostavax), Yellow fever, Measles, Mumps and Rubella (MMR) and BCG vaccine (for tuberculosis) should not be given due to the dampening down of the immune system.
• There is now an inactive Shingles vaccine called Shingrix which can be given along with Upadacitinib therapy.(for over 50s).

Published: 19/08/2024 12:38