According to a study published in the Journal of Pediatrics, use of text messaging was an effective intervention to improve patients’ quality of life, ability to manage their condition, work with healthcare providers, and prevent disease exacerbation. This may offer an effective technique for pharmacists and other members of the healthcare team to monitor diet adherence in patients with celiac disease.
There are currently no FDA-approved medication treatments for celiac disease. However, there is a promising drug in the pipeline, larazotide acetate, that has received fast track designation and belongs to a new class of drugs known as tight junction regulators. Larazotide works by decreasing inflammation in the intestine triggered by gluten, and it is currently in a phase 3 trial that is expected to enroll about 600 patients.
SLE Management and Pipeline Drugs
According to the Lupus Foundation of America, approximately 5 million people globally are affected by lupus and about 16,000 new cases are reported annually. Lupus occurs when the body’s immune system attacks the tissues and organs, which can affect various body systems. Diagnosis is determined through a multifaceted approach with the combination of blood and urine tests, signs and symptoms, and physical examination. Symptoms generally include fatigue, fever, joint pain, photosensitivity, and a butterfly-shaped rash. Systemic lupus erythematosus (SLE) is the most common form of the four types of lupus.
According to a study published in Arthritis Research & Therapy, transitional care improved self-care and quality of life in SLE patients and reduced hospital readmissions. Pharmacists can play an important role in managing chronic medications for patients with SLE. NSAIDs, such as naproxen and ibuprofen, may be used for pain and swelling associated with SLE. Counseling points include an increased risk of cardiovascular and kidney adverse effects as well as stomach ulcers, which can occur even on short-term therapy with NSAIDs.
Hydroxychloroquine, the antimalarial drug, is commonly prescribed to decrease lupus flares. Side effects may include GI issues and damage to the retina, so it should be taken with food and patients should see an ophthalmologist prior to starting hydroxychloroquine.
Corticosteroids (e.g., prednisone) may be used to reduce inflammation, and adverse effects may include weight gain, osteoporosis, hypertension, diabetes, glaucoma, and increased risk of infection. Immunosuppressants such as azathioprine and mycophenolate mofetil are also used for severe SLE cases, and potential adverse effects may include infection risk, liver damage, decreased fertility, and an increased risk of cancer.
The biologic belimumab (Benlysta) was approved in 2011 for SLE in adults and received approval April 2019 as the first treatment for SLE in pediatric patients. The most common side effects associated with Benlysta include nausea, diarrhea, fever, and infusion reactions. Pharmacists should recommend that patients receive an antihistamine prior to Benlysta infusions to prevent a reaction.
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Adrijana Kekic, PharmD, BCACP, Pharmacogenomics Pharmacist at the Mayo Clinic College of Medicine and Science, Phoenix, AZ, uses pharmacogenomics testing when making medication recommendations for patients with SLE with a personalized medicine approach. One example Kekic provided was thiopurine methyltransferase (TPMT) genotyping prior to initiating treatment with azathioprine, which facilitates identifying patients who are at increased risk for toxicity. Kekic also provides counseling tips as part of her patient consultations. “I recommend exercise and stress reduction for my SLE patients,” says Kekic, which can help improve energy and decrease lupus flares.
There are various drugs in the pipeline for SLE in phase 3 clinical trials, according to Kekic. Baricitinib (Olumiant) is FDA approved for rheumatoid arthritis and has been granted fast track status for the treatment of SLE.
One promising therapy rigerimod (Lupuzor), a novel biologic, failed to meet the primary endpoint in a phase 3 study based on clinical trial results reported in 2018. However, rigerimod met the primary objective of the open label extension study evaluating the safety and tolerability of the drug in patients with SLE, demonstrating no serious adverse effects in 62 patients. However, further studies are necessary with a larger number of study participants to determine the rigerimod’s fate.