Rheumatology Biologic Service

The rheumatology multidisciplinary biologic team

The rheumatology multidisciplinary team consists of: rheumatology doctors; clinical nurse specialists; administration staff and pharmacists.

What are the biologic and small molecule synthetic drugs?

These Drugs were developed scientifically to target inflammatory pathways and proteins in the body that cause the symptoms of rheumatological diseases such as Rheumatoid Arthritis.

Why do we consider biologic drugs differently to DMARDS?

Biologic drugs have revolutionised the treatment of rheumatic diseases and help millions of people around the world. They tend to work more quickly than conventional DMARDS. However, they are considered to be more potent than conventional DMARDs drugs. This means that they may cause patients some side effects, such as increased risk of infection. For this reason, they need to be used sensibly and may not be suitable for all patients.

National Institute for Clinical Excellence (NICE) has published guidance about when patients would be suitable / eligible for treatment with each biologic drug. The conditions we can use these drugs for are: Rheumatoid arthritis (RA); Psoriatic arthritis (PsA); ankylosing spondylitis (AS) and Juvenile idiopathic arthritis (JIA). In rare occasions we use biologic drugs for conditions such as vasculitis, myositis or lupus under the guidance of NHSE specialist commissioning.

What are the different types of biologic drugs

Here is a list of the current biologic drugs and the pathways they target in your body.

Pathway Drugs What types of diseases are they used to treat? How are they given?
Anti-IL6 drugs Tocilizumab, Sarilumab RA, JIA (tocilizumab only) Injection at home. Tocilizumab can be given as drip in hospital rare occasions
Anti-TNF drugs Adalimumab, Etanercept, Golimumab, Certolizumab, Infliximab RA, PsA, AS, JIA (only adalimumab and etanercept)

Injection at home

Infliximab can be given as drip in hospital in rare occasions

Anti-CD20 (B cell depletion) Rituximab RA and some rarer conditions such as vasculitis or myositis Only as a drip in hospital
Anti-CD40 drugs Abatacept RA, JIA Injection at home. Abatacept can be given as drip in hospital rare occasions
Anti-IL17 drugs Secukinumab, Ixekizumab PsA, AS (secukinumab only) Injection at home
Anti-IL12/23 drugs Ustekinumab PsA Injection at home
JAK inhibitors* Baricitinib, Tofacitinib RA, PsA Tablets

*these drugs are not strictly biologic drugs but targeted synthetic small molecules. Essentially we shall consider them in this presentation as biologic treatments)

For patients just starting a biologic drug

If your rheumatology team considers that your rheumatic disease should be treated with a biologic drug you will be:

  • Provided with information on the drug. Here are some useful links for further information
  • Assessed for your how severe your disease is with e.g. a DAS28 score, joint count
  • Asked about risk factors for infection, other health issues that may be important and for example if you are planning to have a baby or plans for exotic holidays!
  • A set of blood tests and a chest x-ray will be requested to screen you for some infections including: Hepatitis, HIV and tuberculosis. We also want to check that you have had chicken pox and are immune to this virus.
  • You will be referred to the Virtual Biologic clinic

The Virtual Biologic clinic (VBC)

This is a multidisciplinary team that will first ensure that you are eligible and you have not health risk safe to receive the biologic drug.

  • The team will provide up to date patient information about biologic therapies either via email or as group education.
    • If the drug you are to receive is an injection you do yourself at home the VBC will organise the prescription and register you with a homecare provider. The home care provider may be a company, such as Healthcare @ Home, and they teach you how to use the medication.
      • As we are telling an external company about your details, address etc we will need your consent for this.
  • If the drug you are to receive is a drip, we will organise this with our medical daycase unit on ward A4 at Russells Hall hospital. The phone number for the medical daycase is ext. 3365

For patients already on biologic drugs

Do patients on biologic drugs need to do anything differently?

For detailed guidance see document Guidelines for Rheumatology patients on biologic therapy and you may also want to reread the pre-biologic education presentation.

In brief:

  • If you are unwell or develop symptoms of any infection, we would advise that you should stop your biologic therapy until you feel well again.
  • You need to attend clinic appointment either face2face or virtually to make sure that your disease is controlled by the drug and that you are not experiencing unwarranted side effects.
  • Please have blood tests every 3 months (or monthly for tocilizumab and sarilumab)
  • If you are unwell/ planning surgery/ pregnancy or exotic holidays please make sure you tell the medical team you see that you are on a biologic drug for your rheumatic condition.

If you are traveling abroad and need to take medication with you please contact the helpline.

Who to contact

  • Helpline: 01384 244789 option 1
  • Rheumatology Biologic co-ordinator: 01384 456111 ext 4297
  • Biologic Pharmacy team: 01384 456111 ext 4508

A list and contact details of our currently used Home Care Providers companies:

Company Drugs Email Address Contact Number
Healthcare at Home (HC@H)
  • Benepali
  • Cimzia
  • Enbrel
  • Golimumab
  • Humira
  • Hyrimoz
  • Ixekizumab
  • Tofacitinib
  • Hah.rxmanagement@nhs.net
  • Cyan.hulland@nhs.net
0333 103 9811
Lloyds Pharmacy

Abatacept

Baricitinib

Secukinumab

Tocilizumab

  • Lpch.prescriptionsmgmt@nhs.net
0345 263 6119
Healthnet

Sarilumab

Tocilizumab (new patients from 2020)

  • Healthnet.homecare@nhs.net

 

0800 083 3060
Calea Adalimumab (Idacio)
  • fkl.pharmacy- biosimilars@nhs.net

01928 533738

0800 0902 461