Latest / Pharmacy Podcast Network / The Role of Specialty Pharmacy in Hidradenitis Suppurativa Care at University of Vermont (UVM) Health| NASP Specialty Pharmacy Podcast

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The Role of Specialty Pharmacy in Hidradenitis Suppurativa Care at University of Vermont (UVM) Health| NASP Specialty Pharmacy Podcast · Pharmacy Podcast Network

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  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
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• 0:26
  Speaker 2: You're listening to the NASP Specialty Pharmacy Podcast, a collaboration
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  Speaker 4: Hello.
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  Speaker 5: My name is Sheila Arquette, and I am the President
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  Speaker 5: and CEO of the National Association of Specialty Pharmacy. I
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  Speaker 5: am delighted to welcome my special guests, Santana Van Dyke,
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  Speaker 5: MD and Ryan Lackey, pharm d CPPs to this episode
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  Speaker 5: of the NASP podcast. Santana Van Dyke is an Assistant
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  Speaker 5: Professor of Dermatology and the director of the Hydridinitis super
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  Speaker 5: Tiva Clinic at University of Vermont Health. She earned her
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  Speaker 5: medical degree at the Universe of Virginia School of Medicine
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  Speaker 5: and completed her dermatology residency at UVM Health. She is
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  Speaker 5: very passionate about resident fellow teaching and was awarded the
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  Speaker 5: twenty twenty five Graduate Medical Education Educator of the Year
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  Speaker 5: at UVM Health. With the help of her wonderful team,
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  Speaker 5: she strives to provide the most compassionate advanced care for
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  Speaker 5: her HS patients and is passionate about research to advance
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  Speaker 5: treatments and patient centered care for HS patients. Ryan Lackey
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  Speaker 5: is an ambulatory pharmacist clinician at the University of Vermont
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  Speaker 5: Health Specialty Pharmacy supporting the Dermatology Clinic and the co
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  Speaker 5: director of the Hydrogenitis Supertiva Clinic. He earned his Pharmacy
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  Speaker 5: Pharmacy degree from the Albany College of Pharmacy and Health
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  Speaker 5: Sciences and completed his pharmacy residency training and ambulatory care
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  Speaker 5: and specialty pharmacy at Dartmouth Health. He is passionate about
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  Speaker 5: optimizing medication management, comprehensive patient care, and prioritizing safety to
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  Speaker 5: enhance patient outcome. Santana and Ryan, thanks so much for
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  Speaker 5: joining me today.
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  Speaker 4: Now we're happy to be here. Thanks for having us.
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  Speaker 6: Yes, thank you so much for having us.
• 3:09
  Speaker 3: So can you.
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  Speaker 5: Please give us a brief overview of hydrogenitis super tiv,
• 3:14
  Speaker 5: the presentation, the staging, and common treatments.
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  Speaker 4: Absolutely, so, HS or hydrodenitis superativa, is a very complex
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  Speaker 4: condition that we treat primarily in dermatology, but we certainly
• 3:26
  Speaker 4: work with other specialists as well to provide comprehensive care.
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  Speaker 4: But it's essentially an auto inflammatory condition. So what that
• 3:35
  Speaker 4: means is the system just has a lot of inflammation
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  Speaker 4: and an HS it's actually primarily affecting the hair follicles
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  Speaker 4: and this can lead to painful cysts and abscesses, mostly
• 3:47
  Speaker 4: in the armpits, groin and under the breast for some people,
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  Speaker 4: and it can lead to inflammation that actually tunnels under
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  Speaker 4: the skin and forms what we call skin tunnels, as
• 3:58
  Speaker 4: well as significant scal and it can be really really
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  Speaker 4: debilitating for patients because it can be quite painful. They
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  Speaker 4: can have a lot of drainage, which can affect social life, work,
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  Speaker 4: and mental health definitely. And then in terms of age,
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  Speaker 4: really anyone can get HS. We most commonly see it
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  Speaker 4: present in women in their twenties and thirties as well
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  Speaker 4: as teenagers, but people can also get it later in
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  Speaker 4: life and it affects both men and women. And then
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  Speaker 4: in terms of staging, there are a variety of staging methods,
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  Speaker 4: but we primarily use the Hurley staging system, which is
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  Speaker 4: based on the amount of scarring and skin tunneling that
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  Speaker 4: patients have. And there are a variety of treatments. We
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  Speaker 4: wish there were more treatments available, but we finally do
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  Speaker 4: have some. It's a condition that really wasn't studied for
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  Speaker 4: a very long time, so really in the last ten
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  Speaker 4: to fifteen years they've been doing a lot of research
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  Speaker 4: on medication. So we have some topicals that we use,
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  Speaker 4: like chlorhexidine, which is an antiseptic, as well as clindamycin lotion.
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  Speaker 4: We do some oral medication such as doxycycline which helps
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  Speaker 4: with inflammation. Spronalacton can help if there's a possible hormonal component,
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  Speaker 4: which I'm sure we'll chat a little bit about later,
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  Speaker 4: and then the FDA approved medications are at A, limma mab, secukinamap,
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  Speaker 4: and bemichismab, which are all biologic medications that help with
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  Speaker 4: the inflammation.
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  Speaker 6: I have a quick.
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  Speaker 5: Question is that skin tunneling. Is it visible to the
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  Speaker 5: naked eye? Can you see that on a patient?
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  Speaker 4: Yes, you can actually see it, So essentially what it
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  Speaker 4: looks like is most patients will have some scarring and
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  Speaker 4: then you'll see an opening and if you take a probe,
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  Speaker 4: you can actually go into that skin tunnel and follow it.
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  Speaker 4: And they can be quite extensive and more severe cases
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  Speaker 4: get really inflamed and cause constant drainage for patients, which
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  Speaker 4: can be really devastating.
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  Speaker 5: Oh my gosh, is it painful as well?
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  Speaker 4: Oh? Yes, very very pain full at times, and it's
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  Speaker 4: very it's it's frustrating for patients because for the longest time,
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  Speaker 4: people weren't really aware of this condition, so it would
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  Speaker 4: often get misdiagnosed as bibliculaitis or what some people would
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  Speaker 4: call boils and tell patients, you know, you need to
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  Speaker 4: shower more, things like that, and it has nothing to
• 6:18
  Speaker 4: do with cleanliness or or anything like that. So that's
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  Speaker 4: something I always like to stress to my patients because
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  Speaker 4: sometimes they'll come in and say, I shower multiple times
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  Speaker 4: a day, and I'm like, it's not because you're not
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  Speaker 4: clean enough. You have this auto inflammatory condition that's causing this,
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  Speaker 4: And it's just devastating that people have actually been told
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  Speaker 4: that in the past.
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  Speaker 5: Of course, of course I find it very interesting. And
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  Speaker 5: is there any researcher do we have any idea as
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  Speaker 5: to why so somebody's hair follicles get attacked, somebody's joints
• 6:47
  Speaker 5: and are get attacked, somebody has psoriasis in the plaques
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  Speaker 5: like ankle little things, spondylitus. Is there any do we
• 6:53
  Speaker 5: know why that happens? Or right, like, why everybody just
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  Speaker 5: doesn't have this?
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  Speaker 4: Yeah, So it it's more of an auto inflammatory process,
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  Speaker 4: which is similar to psyriasis, where they's like a cure
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  Speaker 4: antibody that's attacking the hair follicles. There's so much research
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  Speaker 4: being done looking at genetics. Hormones play a huge role,
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  Speaker 4: so we have a lot of patients. We're looking at
• 7:16
  Speaker 4: patients on spernal actone because progesterone, like hormonal therapies like
• 7:23
  Speaker 4: the hormonal IUDs, the hormonal implants, the progesterone injections, all
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  Speaker 4: those things can actually flare HS. So it does seem
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  Speaker 4: to have a pretty strong hormonal component. In some cases,
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  Speaker 4: some people are genetically predisposition if they smoke cigarettes, that
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  Speaker 4: can actually set off the inflammatory cascade. There's some studies
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  Speaker 4: going on about bacterial dysbiosis. There's so many things that
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  Speaker 4: they're studying that can contribute. And that's part of what
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  Speaker 4: makes treating this condition so interesting and special is because
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  Speaker 4: we really get a look at each person and look
• 8:01
  Speaker 4: at you know, what might be causing this person's HS
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  Speaker 4: and what treatment might work best for them.
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  Speaker 5: So how is your clinic set up, including like what
• 8:09
  Speaker 5: type of professionals are involved and how is each of
• 8:11
  Speaker 5: them involved in patient care?
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  Speaker 6: Yeah, absolutely, I'm happy to review that. So you already
• 8:19
  Speaker 6: met us. But our clinic director or attending position is Santana.
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  Speaker 6: She runs the show, she's all of our patients.
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  Speaker 4: Ryan runs the show modest.
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  Speaker 6: And then you have me, I am our co director,
• 8:36
  Speaker 6: and pharmacists helping with medication management and answering questions. We
• 8:42
  Speaker 6: also have a lovely medical assistant, Bella, who helps ruin
• 8:46
  Speaker 6: our patients, get past medical history, review medications, et cetera.
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  Speaker 6: We also have wonderful nurses who help during procedures with
• 8:57
  Speaker 6: post boon care and more. And lastly, but not least,
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  Speaker 6: we have a wonderful group of medical and pharmacy residents
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  Speaker 6: and students who rotate through our clinic and help us
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  Speaker 6: see our patients and they are a major part of
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  Speaker 6: our patient's success.
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  Speaker 5: So, I know we talked about right that this there
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  Speaker 5: hasn't been a lot I guess of study or there's
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  Speaker 5: been some forward movement and treatments. But what treatments do
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  Speaker 5: you find most effective for HS? And we're including like
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  Speaker 5: medications and any type of procedures. I don't know if
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  Speaker 5: this is like a UV light kind of thing. You know,
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  Speaker 5: I'm thinking a little bit of psoriasis only because it's
• 9:37
  Speaker 5: another skin type condition. But what do you find most effective?
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  Speaker 6: Yeah? Absolutely, I'm happy to review some of the ones
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  Speaker 6: that I find most effective for our patients if they
• 9:48
  Speaker 6: can take it. Our most effective treatment is probably inflixa mab,
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  Speaker 6: which is an ivy TNF alpha inhibitor. Unfortunately, this is
• 10:01
  Speaker 6: not FDA approved and so most of the time insurances
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  Speaker 6: will not pay for this first line, and so it
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  Speaker 6: is not something we can always get covered right away,
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  Speaker 6: although it is one of the most effective, and so
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  Speaker 6: since we can't always get that, we will most of
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  Speaker 6: the time first line for patients with early stage two
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  Speaker 6: to three, so moderate to severe disease go for at
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  Speaker 6: a limu map, which is a subcutaneous injected NFLFA inhibitor,
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  Speaker 6: and this is still very very effective for patients with HS,
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  Speaker 6: and it is dosed we typically dose it weekly, although
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  Speaker 6: it can be dosed every other week, although there is
• 10:47
  Speaker 6: more evidence for weekly dosing. Other treatments that we find
• 10:52
  Speaker 6: really effective. ID pharmacists and providers you know, beware, but
• 11:00
  Speaker 6: we really love penom infusions. We don't use them too often,
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  Speaker 6: but in patients who have very severe early stage three disease,
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  Speaker 6: who are flaring and need bridge to a treatment like infliximab,
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  Speaker 6: there's nothing like a six week course of daily earth
• 11:16
  Speaker 6: to penem that gets a patience disease. Controlled patients report
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  Speaker 6: improvement in inflammation, pain, swelling, and basically resolution of their flares,
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  Speaker 6: typically within days. And it I don't know if we
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  Speaker 6: have had a patient so far who hasn't been completely
• 11:34
  Speaker 6: controlled after their course of the earth to penem. And
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  Speaker 6: so it is very very effective. That's an antibiotic. Correct,
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  Speaker 6: that is an antibiotic. Shally, you are correct, strong it
• 11:46
  Speaker 6: is don't come for us. Yeah, it is a very anabatic.
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  Speaker 6: And it's interesting because we don't know a lot about
• 11:53
  Speaker 6: why it works so well for HS. Because a lot
• 11:55
  Speaker 6: of other antibiotics we use for HS, such as doxycycling
• 11:59
  Speaker 6: we know have has anti inflammatory benefits. URDA penem doesn't
• 12:04
  Speaker 6: show those same benefits. So we don't know exactly why
• 12:07
  Speaker 6: it works so well, but it does, and the case
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  Speaker 6: series and the studies show that it is very effective
• 12:14
  Speaker 6: for HS lesions and reducing flairs and flair intensity.
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  Speaker 5: Okay, well, who cares why it works, It just does.
• 12:25
  Speaker 4: Thank God?
• 12:25
  Speaker 6: Right for these I'm sure.
• 12:28
  Speaker 5: Yeah, my pair of friends wouldn't like to hear me
• 12:30
  Speaker 5: say that, but still right, Like sometimes it's stumbling on
• 12:33
  Speaker 5: a discovery like this, right, that new treatments are are
• 12:37
  Speaker 5: established and added to the guidelines. Absolutely, any like looking
• 12:43
  Speaker 5: down the pipeline, any treatments that are upcoming that you're
• 12:48
  Speaker 5: interested in or you're excited about and looking forward to.
• 12:52
  Speaker 3: Yeah.
• 12:52
  Speaker 4: So the really exciting thing about HS right now is
• 12:56
  Speaker 4: they're doing so much research and there are so many
• 12:59
  Speaker 4: things come down the pipeline. And I always tell patients who,
• 13:03
  Speaker 4: you know, many of my patients have been our patients
• 13:06
  Speaker 4: have been struggling with this for decades, and I say,
• 13:08
  Speaker 4: you know, as frustrating as this condition is, it is
• 13:11
  Speaker 4: being studied a lot right now, and there are more
• 13:13
  Speaker 4: and more treatments on the way, which is very exciting
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  Speaker 4: and long overdue.
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  Speaker 6: And so one of the.
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  Speaker 4: Areas I feel like where we don't have many treatments
• 13:22
  Speaker 4: at all is for really early stage disease where patients
• 13:25
  Speaker 4: might not qualify for one of the FDA approved biologics
• 13:29
  Speaker 4: but do need treatment. So they're actually looking at a
• 13:33
  Speaker 4: topical jack inhibitor called ruxelidiniv cream for HS, primarily for
• 13:39
  Speaker 4: mild to moderate disease. And then going along with our
• 13:44
  Speaker 4: TNF alpha trey and there's Rebecca Meg, which is a
• 13:47
  Speaker 4: TNF alpha and oxfordygan inhibitor that's being studied for moderate
• 13:53
  Speaker 4: to severe disease. And I think that's very exciting because
• 13:56
  Speaker 4: I'm hoping the broader mechanism of action might actually help
• 14:01
  Speaker 4: those patients who have responded to the TNF alvin in hippoters,
• 14:04
  Speaker 4: but maybe not as much as we would like. So
• 14:06
  Speaker 4: I'm really excited to see what comes down the line
• 14:09
  Speaker 4: with that.
• 14:11
  Speaker 5: So how does this specialty pharmacist complement the clinic and
• 14:16
  Speaker 5: what further benefits does the pharmacist provide for patients.
• 14:21
  Speaker 4: Well, I'm going to start because I know Ryan's not
• 14:23
  Speaker 4: going to toot his horn as he should, but Ryan
• 14:26
  Speaker 4: is the heart and soul of our HS clinic. I
• 14:30
  Speaker 4: really could not do this without him, and he just
• 14:33
  Speaker 4: allows us to take such amazing care of our patients.
• 14:36
  Speaker 4: And I love bragging on him and working with him
• 14:40
  Speaker 4: every day. So he really helps just communicate with the patients.
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  Speaker 4: I think is the biggest thing for me. He does
• 14:50
  Speaker 4: injection trainings at times, he goes in and counsels the patients,
• 14:55
  Speaker 4: helps me with any questions or ideas that I have
• 14:59
  Speaker 4: and lets me know if we might be able.
• 15:01
  Speaker 6: To get them covered.
• 15:02
  Speaker 4: When I get the eye roll. I know it's probably
• 15:04
  Speaker 4: a no wild ideas at times, and then you know
• 15:10
  Speaker 4: I as a dermatologist, I'm a little bit far removed
• 15:13
  Speaker 4: from my intern year when I was prescribing all kinds
• 15:16
  Speaker 4: of medications. So he helps answer my questions about medication interactions.
• 15:21
  Speaker 4: I'm like, oh no, it says it's going to prolong
• 15:23
  Speaker 4: the QTc. It's like, it's fine, It's fine. So it's
• 15:27
  Speaker 4: great to have him there for that support. But really
• 15:30
  Speaker 4: just he's a great colleague, great friend, and I couldn't
• 15:33
  Speaker 4: do this without him.
• 15:35
  Speaker 6: I think it's just exciting to get to work in
• 15:37
  Speaker 6: a clinic where I get to work at the top
• 15:39
  Speaker 6: of my license and really help guide and manage care
• 15:42
  Speaker 6: for these patients who who really deserve a lot of support.
• 15:48
  Speaker 6: I think getting to provide that pharmacist perspective and having
• 15:53
  Speaker 6: provider who's so open to that is also really rewarding.
• 15:56
  Speaker 6: And like Santana said, I'm love my job and when
• 16:01
  Speaker 6: people ask, I always say, my favorite part of my
• 16:03
  Speaker 6: job is getting to talk to patients because it's one
• 16:05
  Speaker 6: of the things I'm best at is talking if you
• 16:07
  Speaker 6: couldn't tell, and so I get to come in and
• 16:09
  Speaker 6: just chat with patients all day and I love it.
• 16:11
  Speaker 6: So I'm very lucky to be in the position I'm in.
• 16:15
  Speaker 4: And our patients love him. Every time I go in
• 16:18
  Speaker 4: the room, They're like that guy Ryan, he is so
• 16:22
  Speaker 4: wonderful is he here today? We even have some patients
• 16:25
  Speaker 4: who will come and see him after their appointments if
• 16:27
  Speaker 4: they're not in our HS clinic, just to I think
• 16:31
  Speaker 4: that shows how wonderful he is and what a great
• 16:34
  Speaker 4: asset he is for a patient here.
• 16:37
  Speaker 5: Yeah, that's awesome too, And I think it's really a
• 16:39
  Speaker 5: great demonstration to the patients how a highly effective multidisciplinary
• 16:43
  Speaker 5: team works together right where. I think sometimes people expect
• 16:47
  Speaker 5: physicians to know everything right and not that they don't
• 16:50
  Speaker 5: know a whole lot, but I think it's unfair right
• 16:53
  Speaker 5: to expect that, And I love when they reach out
• 16:56
  Speaker 5: to the colleagues that are the subject matter experts like
• 16:58
  Speaker 5: Ryan and you know, the medication and treatments and lean
• 17:02
  Speaker 5: on them and for their expertise.
• 17:05
  Speaker 4: No, absolutely, it's really I wish more clinics would incorporate
• 17:11
  Speaker 4: this model because I think it just works so well
• 17:13
  Speaker 4: and it really does improve patient outcomes, and I think
• 17:17
  Speaker 4: that's very very clear from the work we do every
• 17:19
  Speaker 4: day together.
• 17:21
  Speaker 6: We make a good team.
• 17:21
  Speaker 4: Yeah.
• 17:23
  Speaker 6: Awesome.
• 17:24
  Speaker 5: So are there any areas of research that you are
• 17:28
  Speaker 5: currently involved in or you'd like to be involved with.
• 17:32
  Speaker 6: Yeah, we are doing a little bit of research ourselves
• 17:36
  Speaker 6: right now. We are actually working on a case series
• 17:40
  Speaker 6: treating patients with HS with the GLP one and GIP
• 17:45
  Speaker 6: really medication. Yeah, absolutely, we're working on that right now.
• 17:49
  Speaker 6: I'm almost in the final stages, which is very exciting.
• 17:54
  Speaker 6: We are doing some more research on sparanalacton and HS.
• 17:57
  Speaker 6: I'm looking at the outcomes there. We have a case
• 18:02
  Speaker 6: report on a patient who was on at a LIMA
• 18:04
  Speaker 6: mab and we had to get hematology involved, which was
• 18:07
  Speaker 6: a really interesting case. And right now we are starting
• 18:11
  Speaker 6: to get clinical trials started here at UVM Dermatology. So
• 18:16
  Speaker 6: we have a lot of exciting upcoming research projects that
• 18:19
  Speaker 6: are on the horizon and you know, hopefully we'll be
• 18:22
  Speaker 6: published soon.
• 18:22
  Speaker 5: So it's very exciting, right, and I hope you'll you
• 18:25
  Speaker 5: will you could publish with us, right we have a
• 18:27
  Speaker 5: partner journal and you could present at our conference.
• 18:29
  Speaker 6: We would love that. Oh amazing, Oh that would be wonderful.
• 18:33
  Speaker 6: That would be wonderful. You are on the list. You
• 18:36
  Speaker 6: don't worry, all.
• 18:37
  Speaker 5: Right, thank you, thank you, or we will even gladly
• 18:41
  Speaker 5: open arms, welcome and encore presentation because like you said, right,
• 18:44
  Speaker 5: there isn't hasn't been a lot, but recently, I think
• 18:46
  Speaker 5: in the last couple of years, we're hearing this, you know, this,
• 18:50
  Speaker 5: this term a lot more, which which is great, right
• 18:53
  Speaker 5: for the poor people who I'm sure have suffered in
• 18:55
  Speaker 5: silence for quite some time.
• 18:58
  Speaker 4: Yeah, No, it's it's very exciting. And I think one
• 19:00
  Speaker 4: of my favorite parts about treating HS patients. The patients
• 19:03
  Speaker 4: are just so lovely and you know, are very appreciative
• 19:08
  Speaker 4: because they've went through this for so long and suffered
• 19:12
  Speaker 4: without any treatment and now seeing you know, at our
• 19:15
  Speaker 4: most recent dermatology conference, the AAD there were posters everywhere,
• 19:20
  Speaker 4: and just seeing the patient support groups and people on
• 19:24
  Speaker 4: social media, it's it's really exciting because it's a wonderful
• 19:27
  Speaker 4: community and I'm glad that this condition is finally getting
• 19:31
  Speaker 4: attention and research and it's great, long overdue, but great.
• 19:36
  Speaker 5: And I'm sure it's probably a relief to them or
• 19:38
  Speaker 5: comforting to know that it's nothing that they're doing. They're
• 19:41
  Speaker 5: not doing right, it's not because you know, they're there,
• 19:45
  Speaker 5: have a hygiene problem and they're not clean enough. Right,
• 19:47
  Speaker 5: it's none of that, right. I think it's probably almost
• 19:50
  Speaker 5: got to be a relief like show it's not me, right,
• 19:52
  Speaker 5: I couldn't have helped this, I couldn't have prevented this.
• 19:56
  Speaker 4: Yeah, no, absolutely, And I think that's helpful to the
• 19:59
  Speaker 4: more we learn and about it, we can you know.
• 20:02
  Speaker 4: And it's a very complex condition. So there are some
• 20:05
  Speaker 4: people really there's a genetic component, some people it's hormonal.
• 20:09
  Speaker 4: There's so many different factors that go into play, and
• 20:12
  Speaker 4: really being able to individualize each patient's care is so
• 20:16
  Speaker 4: rewarding and so important. And yeah, we love our jobs absolutely.
• 20:22
  Speaker 5: Oh, you can definitely tell that passion shows through for sure.
• 20:26
  Speaker 6: Well.
• 20:27
  Speaker 5: I want to thank you so much Santana and Ryan
• 20:29
  Speaker 5: for chatting with me and sharing this valuable HS information
• 20:33
  Speaker 5: and really appreciate it.
• 20:35
  Speaker 4: Oh well, thank you for having us.
• 20:36
  Speaker 6: Yes, thank you so so much. It was a lot
• 20:38
  Speaker 6: of fun. I had a great time.
• 20:40
  Speaker 5: As a reminder, NSP corporate members are invited to be
• 20:42
  Speaker 5: my guest on one complimentary podcast per year. For more
• 20:46
  Speaker 5: information about this or other NASP membership benefits and events,
• 20:49
  Speaker 5: please feel free to reach out to membership at nasp
• 20:53
  Speaker 5: net dot org or visit our website at www dot na,
• 20:58
  Speaker 5: sp n et dot RG. Until next time, have a
• 21:02
  Speaker 5: great day.