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juvenile arthritis

How ContinuumRx Treats Juvenile Idiopathic Arthritis

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Arthritis is a condition that affects roughly 24% of all American adults. However, arthritis can also be an issue in children, and it is estimated that nearly 300,000 children in the U.S. have juvenile arthritis. Since July is Juvenile Arthritis Awareness Month, we wanted to take a closer look at juvenile arthritis, specifically juvenile idiopathic arthritis (JIA), and discuss how ContinuumRx can treat JIA patients from home or at one of our infusion locations.

Causes and Symptoms

Simply put, JIA is an autoimmune or autoinflammatory condition caused when the immune system mistakes the tissues and cells surrounding joints for germs or viruses and attacks them. The exact reason JIA occurs is unknown, but it is the most common type of arthritis in children under sixteen. The severity of JIA differs by case, but the following symptoms are generally present in individuals with the disease:

  • Pain
  • Swelling
  • Stiffness
  • Rashes, fevers, or swollen lymph nodes

While these symptoms are common for any arthritis patient, depending on the severity, they can cause issues with joint growth and development and inflict long-term damage on juvenile patients.

Treatment

There are various types of treatments for JIA, and some physicians may prescribe infusion therapy to help improve symptoms and prevent further joint damage.

Humira

One source of inflammation in patients with JIA is an overproduction of a hormone, tumor necrosis factor (TNF). Humira targets and blocks TNF-alpha, relieving symptoms of pain, stiffness, and swelling in the joints. Humira can be administered in children two years or older and is commonly used to treat JIA patients and adults with arthritis.

Rituxan

Rituxan works differently from other arthritis infusion drugs since it is not a TNF inhibitor. Instead, Rituxan or rituximab works by depleting levels of B-cells in the body which is a cell type that is thought to cause swelling and joint pain. In a 2018 study, it was found that rituximab was a potentially effective treatment method for patients with JIA that did not respond to TNF inhibitor therapy.

Kineret

Kineret has been shown to be effective as an early treatment for JIA. This medication works by blocking the activity of interleukin-1 (IL-1), a protein that causes inflammation. In addition to JIA, Kineret is often used to treat rheumatoid arthritis in adults, neonatal-onsite multisystem inflammatory disease, and deficiency of interleukin-1 receptor antagonist.

Orencia

Orencia can be used in children aged two or older to treat JIA. Orencia works by binding to two proteins that activate T cells which are primarily responsible for attacking joints in arthritis patients. These proteins are CD80 and CD86 and are located on the surface of specific immune cells. By blocking these proteins, Orencia decreases T cell proliferation and can reduce inflammation and other symptoms in patients with JIA and other forms of arthritis.

Since JIA is so complex, a physician will determine the best course of treatment for the patient. No matter which infusion medication your child is prescribed, ContinuumRx can help save you time and money by delivering your therapy from home or one of our comfortable and conveniently located infusion suites. Contact us today to learn more!

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Treating Severe Persistent Asthma with Biologic Therapy

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For most asthma sufferers, asthma can be adequately managed with inhaler therapy. Some patients, however, have more severe asthma episodes, more frequent symptoms, and more progressive disease. These asthma cases usually cannot be managed with inhaler therapy alone. Thankfully, biologic therapies exist, offering an additional option for severe asthma sufferers. These medications, referred to as “biologics”, target different biological pathways, allowing them to treat more serious diseases. They are available via the intravenous (IV) or subcutaneous route, meaning they are administered through a vein. This article will discuss available biologic therapies for severe persistent asthma.

Cinqair (reslizumab)

Use: Cinqair is a medication used to treat eosinophilic asthma. Eosinophilic asthma is a severe form of asthma characterized by increased white blood cell levels known as eosinophils, which are an important component of the body’s immune system.

Administration: Cinqair is administered intravenously at a dose of 3 mg/kg once every four weeks, with each infusion lasting between twenty to fifty minutes. It is suggested that patients undergo at least four months of treatment before determining treatment effectiveness.

Side effects: Cinqair can cause the following common side effects:

  • Sore throat
  • Increased creatine phosphokinase levels (an enzyme in the body)
  • Muscle pain
  • Severe allergic reactions (rare)

Fasenra (benralizumab)

Use: Fasenra is indicated for eosinophilic asthma, as it helps asthma symptoms by decreasing eosinophil levels in the blood.

Administration: Fasenra is given subcutaneously as a shot under the skin. It is administered at a dose of 30 mg every four weeks for the initial three doses and then once every eight weeks thereafter. It is suggested that patients undergo at least four months of treatment before determining treatment effectiveness.

Side effects: Fasenra can cause the following common side effects:

  • Headache
  • Sore throat
  • Fever
  • Severe allergic reactions (rare)

Nucala (mepolizumab)

Use: Nucala is indicated for eosinophilic asthma, as it helps asthma symptoms by decreasing eosinophil levels in the blood.

Administration: Nucala is given subcutaneously as a shot under the skin. It is administered at a dose of 100 mg every four weeks. It is suggested that patients undergo at least three to six months of treatment before determining treatment effectiveness.

Side effects: Nucala can cause the following common side effects:

  • Headache
  • Injection site reaction (e.g., burning, pain, itching, or swelling at the injection site)
  • Back pain
  • Joint discomfort
  • Fatigue
  • Allergic reactions
  • Weakness

Dupixent (dupilumab)

Use: Dupixent is indicated for eosinophilic asthma, as it helps asthma symptoms by decreasing levels of inflammatory cells in the body.

Administration: Dupixent is given subcutaneously as a shot under the skin. It is administered at a dose of 400 mg once (given as two 200 mg injections) and then 200 mg every other week thereafter. It can also be given at a dose of 600 mg once (given as two 300 mg injections) and then 300 mg every other week thereafter. It is suggested that patients undergo at least four months of treatment before determining treatment effectiveness.

Side effects: Dupixent can cause the following common side effects:

  • Sore throat
  • Injection site reaction (e.g., pain and redness)
  • Increased eosinophil levels
  • Severe allergic reactions (rare)

Contact us if you are interested in learning how you can start your treatments with at home infusion therapy and bring more flexibility into your life.

References

  1. Biologic therapy for severe asthma. (n.d.). Cleveland Clinic. Retrieved May 17, 2022, from https://my.clevelandclinic.org/health/treatments/17711-biologic-therapy-for-severe-asthma
  2. Lexicomp. (n.d.). Retrieved May 17, 2022, from https://online.lexi.com/lco/action/home
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Inflammatory Bowel Disease: Benefits of Infused Medications

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Several treatment options are available to help manage inflammatory bowel disease (IBD). These options come in different forms and can be taken in various ways. Most commonly, IBD therapies are provided orally (PO), subcutaneously (SQ), or intravenously (IV). Each therapeutic option and route of administration carries its own benefits and risks. This article will discuss each of these options and why IV infusion therapy may be of particular benefit to patients.

Overview of IBD therapies and routes

IBD medications include corticosteroids, 5-ASA drugs, immunomodulatory agents, and biologics. Corticosteroids have anti-inflammatory properties, which is why they are used for quick and short-term relief of IBD symptoms. Corticosteroids can be taken by mouth, as an enema, or via an IV infusion. In addition, 5-ASA medications, also known as aminosalicylic acids, are another common class of medication indicated for IBD that come in many forms. Mesalazine, for example, is available as oral tablets. Other types of 5-ASA drugs can be supplied as suppositories, foams, and enemas. IBD can also be treated with immunomodulatory agents such as azathioprine or methotrexate. Immunomodulatory agents are available in oral or injection formulations. Finally, IBD can be treated with biologic medications that are given IV1.

Benefits of IV medication

The intravenous route of administration delivers medication directly into your bloodstream. Because it utilizes this method, a medication can enter your bloodstream and system more quickly compared with other routes. When taking a drug by mouth, your body must undergo an absorption process that takes time and usually does not absorb 100 percent. IV infusion allows your body to achieve adequate drug levels in the blood faster, causing a more rapid and sustained therapeutic effect2. Because of this, IBD patients commonly turn to IV agents instead of oral or injection medications.

In the context of IBD, common infusions therapies can include biologic medications such as Remicade (infliximab), Entyvio (vedolizumab), Stelara (ustekinumab), or Cimzia (certolizumab pegol)3 These agents are highly efficacious, thereby providing relief to many patients with IBD. These therapies have a robust efficacy profile for IBD compared with other medications that are given orally or via SQ injection. They are particularly useful for IBD cases that are unresponsive to oral medications.

As an example, consider the treatment of Crohn’s disease, which is a form of IBD. One study evaluated how Remicade compares with conventional oral treatment for Crohn’s as first-line therapy (azathioprine). Results indicated that using Remicade as a first-line treatment achieved superior outcomes compared with azathioprine therapy alone. On average, patients receiving Remicade were more likely to achieve remission, demonstrating better efficacy4.

In addition to an improved efficacy profile with IV infusion therapy, some patients prefer IV administration for convenience and safety purposes, particularly compared with subcutaneous delivery. Some patients may prefer IV administration under medical supervision as opposed to self-injecting medication themselves. This also allows for greater compliance due to the oversight of a medical professional. Additionally, IV infusions are usually less frequent, occurring every eight weeks as opposed to every one to two weeks. This can provide greater convenience for the patient5. IBD patients can receive infusion therapy at home or at a conveniently located infusion center with ContinuumRx and Continuum Health. Contact us to onboard your therapy today!

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References

  1. Medication for inflammatory bowel disease in adults. (n.d.). Retrieved April 14, 2022, from https://nyulangone.org/conditions/inflammatory-bowel-disease-in-adults/treatments/medication-for-inflammatory-bowel-disease-in-adults
  2. Routes of drug administration. (2018). https://doi.org/10.1016/B978-0-12-801238-3.11099-2
  3. Infusion therapy for Crohn’s disease. (n.d.). Infusion Associates. Retrieved April 14, 2022, from https://infusionassociates.com/infusion-therapy/crohns-disease/
  4. Jongsma, M. M. E., Aardoom, M. A., Cozijnsen, M. A., van Pieterson, M., de Meij, T., Groeneweg, M., Norbruis, O. F., Wolters, V. M., van Wering, H. M., Hojsak, I., Kolho, K.-L., Hummel, T., Stapelbroek, J., van der Feen, C., van Rheenen, P. F., van Wijk, M. P., Teklenburg-Roord, S. T. A., Schreurs, M. W. J., Rizopoulos, D., … de Ridder, L. (2022). First-line treatment with infliximab versus conventional treatment in children with newly diagnosed moderate-to-severe Crohn’s disease: An open-label multicentre randomised controlled trial. Gut, 71(1), 34–42. https://doi.org/10.1136/gutjnl-2020-322339
  5. Jonaitis, L., Marković, S., Farkas, K., Gheorghe, L., Krznarić, Ž., Salupere, R., Mokricka, V., Spassova, Z., Gatev, D., Grosu, I., Lijović, A., Mitrović, O., Saje, M., Schafer, E., Uršič, V., Roblek, T., & Drobne, D. (2021). Intravenous versus subcutaneous delivery of biotherapeutics in IBD: An expert’s and patient’s perspective. BMC Proceedings, 15(17), 25. https://doi.org/10.1186/s12919-021-00230-7
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Treating Multiple Sclerosis With ContinuumRx Infusion Services

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Multiple sclerosis (MS) is a condition in which the body’s immune system attacks the myelin sheath, or the protective barrier surrounding nerves. MS can cause side effects such as numbness or weakness in limbs, issues with motor function, and fatigue. While MS has no known cure, with treatment, patients can experience significant relief from existing symptoms.

Infusion Therapy for MS

Infusion therapy is a treatment where medication is administered directly into the bloodstream intravenously (IV). Most infusion treatments for MS are disease-modifying therapies (DMTs) meaning they suppress the immune system in order to prevent further damage to the myelin sheath. With infusion therapy, some patients may experience a slowed progression of the disease.

It’s important to talk with your doctor to understand your condition and determine if infusion therapy is the best course of treatment. Not all DMTs work the same either, that’s why a physician’s expertise is necessary to determine the infusion medication that is best suited for the patient.

Infusion Medication for MS

There are various infusion drugs that ContinuumRx uses to treat MS, each with its own benefits. Today, we’re highlighting three MS infusion drugs.

• Tysabri (Natalizumab)

Tysabri is an immunosuppressive drug that can subdue the immune system from attacking the nerves, thus improving MS side effects. It is given intravenously once every twenty-eight days and has been shown to reduce the formation of new active brain lesions and reduce the number of relapses in MS patients.

• Ocrevus (Ocrelizumab)

Ocrevus is used to treat relapsing forms of multiple sclerosis (MS) in adults. The conditions include but are not limited to the clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease. When starting Ocrevus, patients will have two initial sessions, each taking place two weeks apart. Following this, they will be given a dose every six months unless otherwise indicated by their physician.

• Lemtrada (Alemtuzumab)

Lemtrada is another infusion medication that works by targeting cells thought to be damaging the myelin sheath. With consistent treatment, Lemtrada removes these cells and improves relapsing MS symptoms over time. Patients beginning Lemtrada will have 8 days of infusion spread over 2 rounds of treatment in approximately twelve months’ time. Treatment following your last infusion will vary by case.

Home Infusion Therapy

While infusion therapy can help slow the progression of MS and even grant some patients remission, the time and cost for travel to and from the hospital can impact patients beyond their bottom line. Home infusion with ContinuumRx allows patients to take back their freedom by delivering their treatment from home. This means patients can receive MS infusions with minimal disruptions to their everyday life and schedules.

If you’re interested in starting home infusion and bringing more flexibility into your life despite your treatment, then contact us for more information on our onboarding process!

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Back-to-School Tips for Young Infusion Patients

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When your child requires infusion therapy, balancing school and treatment can feel overwhelming. While infusion therapy is still a convenient method of care, families may find themselves struggling to schedule time around their child’s treatment. At ContinuumRx, we’re committed to helping navigate patients through the continuum of care, so we’ve compiled a list of our top back-to-school tips for young infusion patients.

1. Collaborate With Your School Nurse

The school nurse’s office can be an excellent resource for school-aged infusion patients. It provides a comfortable and familiar environment for children to receive their infusion therapy with minimal disruptions to their academic schedule. If your school district allows it, the school nurse may also be able to deliver your child’s medication. Some school nurses are already trained in infusion therapy. However, if they are not, then a ContinuumRx infusion nurse can train them on safely administering your child’s medication until they are comfortable delivering it independently.

Unfortunately, not all school districts allow the school nurse to deliver infusion therapy for liability reasons. In this case, if it is permitted, a ContinuumRx infusion nurse can come to the school and administer the medication. Doing so will still allow your child to remain in school during infusions instead of missing a day.

2. Bring Homework to Infusion Sessions

If your child receives their infusion treatment at an infusion site or one of our infusion suites, remember to bring homework to treatment. According to a study conducted by The University of Phoenix College of Education, the average middle schooler has three and a half hours of homework a week. Since some infusion sessions can last four hours or more, bringing homework assignments can help pass the time.

Despite efforts to keep children from missing school, every parent knows that unforeseen sick and missed days are inevitable. So, by utilizing infusion times for homework and studying, your child remains organized and on track no matter what life may throw at you both.

3. Explore Advancements in Infusion Therapy

The infusion therapy industry is rapidly growing, and new medical advancements make treatment simpler and more accessible for patients. When planning your child’s return to school, see if there are any new devices or techniques that can make the transition easier.

For example, total parenteral nutrition (TPN) patients can now utilize backpacks to carry their TPN supplies and infuse while on the go. This can be great for younger TPN patients because their treatment may require daily infusions, cutting into their school time. The backpack also helps conceal their treatment and keep things compact. Your infusion provider can give you a TPN backpack, or you can find a bag of your own that works for your child’s lifestyle. When choosing a backpack, comfort and space are top priorities. Small to medium-sized hiking packs are usually ideal for this reason due to their long-wear padded straps, spacious compartments, and often include a hook for a hydration system that can be used for TPN formula.

4. Consider Home Infusion Therapy

Schedule flexibility is critical when juggling your child’s treatment and school, and sometimes hospitals, doctor’s offices, and infusion sites just aren’t accommodating enough to suit your family’s busy lifestyle. Home infusion is a solution to this issue. By choosing home infusion, you’re putting the power back in your hands and can plan your child’s infusion treatment around a schedule that works for you. 

An added step you can take is communicating with your specialty infusion pharmacy provider and finding out if they have locations in the area you’ll be traveling to. This could be useful for At ContinuumRx, we understand the importance of working with families so that children can lead normal lives outside of their infusion treatment. So, we’ll come before soccer practice, after piano lessons, during lunch, or any time you need us to deliver your child’s infusion medication. Let us handle their treatment so that they can be a kid again. Contact us today to learn how we can help!

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