IV infusions with targeted medications continue to expand
87-year-old resident credits RA remission on regular infusions
A spry Steamboat Springs senior who just celebrated her 87th birthday this week, Karen Street set a goal of walking 9,000 to 10,000 steps a day measured by an app on her cell phone.
Her walking companion is her beloved “puppy” Sunny, a caramel and cream 12-year-old cockapoo. During the wintery weather, Street reduces her goal to 8,000 steps a day. That activity level is impressive for any octogenarian, much less someone who has suffered from rheumatoid arthritis, or RA, for 40 years.
The autoimmune disease and chronic condition can cause joint deformities and joint pain, fatigue, swelling and stiffness, according to the website RA.com.
Street credits her long-term remission from RA to intravenous infusion treatments of Remicade that she receives every eight weeks at UCHealth Jan Bishop Cancer Center in Steamboat. She encourages other people suffering from RA to investigate the option of infusion treatments.
“Don’t wait with the pain because there is so much that can be done,” Street said. “With the advancement in drugs, we’ve seen people with RA with no disfigurement of hands or feet.”
Despite the overall focus on cancer treatments, infusions for non-cancer diseases now account for 50% of all infusions at the Jan Bishop Cancer Center, said Sanaya Sturm, the center’s nurse manager. She said the trend is largely due to the growth in recent years of targeted treatment options that use monoclonal antibodies, which are proteins made in a laboratory meant to stimulate the body’s immune system, according to the Cleveland Clinic.
“That monoclonal antibody therapy is absolutely the driver in pharmacy right now in certain disease states,” said Steve Squires, director of pharmacy at Memorial Regional Health in Craig, which opened a designated infusion center in October 2019. “In pharmacy as a whole, monoclonal antibody therapy will continue to grow at a very rapid pace. They are coming out with new products almost monthly that are site-directed therapies for specific diseases.”
Infusion treatments now are commonly available for conditions such as RA, multiple sclerosis (MS), osteoporosis, acute migraine, anemia, asthma and hyperemesis, or excessive nausea and vomiting during pregnancy.
“You see more and more drugs that are being introduced that treat an exact thing, and I don’t think it’s going to slow down anytime soon,” said Wes Hunter, director of pharmacy at UCHealth Yampa Valley Medical Center.
He noted that advances in MS infusion medicines in the past five years have been “pretty striking” as well as medication improvements for autoimmune diseases such as RA, lupus and Crohn’s disease.
Squires and Hunter explained that monoclonal antibody treatments are administered as IV infusions directly into the blood stream for efficacy. Those large, long-chain protein molecules otherwise could be disrupted if taken orally by the first pass metabolism of the body, where the stomach and liver may impair absorption.
Rheumatologist Dr. Nicole Cotter at UCHealth Rheumatology Clinic in Steamboat said some treatments come in the form of either injections or infusions.
“We choose the drug that would be most appropriate, not necessarily how it is administered,” Cotter explained.
Squires said the Craig infusion center averages 80% non-cancer infusions, and 20% cancer infusions, serving about 120 non-cancer patient visits per month. The top diseases treated by infusions there include RA, MS, lupus and asthma.
Infusion medications are exponentially more expensive than pills, the pharmacists say, but the increasing development of biosimilars, or generic-type infusions, could lower costs.
Sturm said the UCHealth center in Steamboat hired its own infusion financial case counselor this week who focuses on insurance approval of treatments. In addition, the center has thousands of dollars in assistance grants available to decrease out-of-pocket costs for patients.
Although infusion treatments can be more effective, sitting down with an IV attached for anywhere from 30 minutes to three hours is more time consuming. On the positive side, infusions are administered by nurses skilled in helping with possible side effects such as vomiting, rashes, swelling or itching. Infusions can be administered very slowly as opposed to swallowing a pill or receiving an injection, Sturm said.
The nurse manager said infusion appointments doubled from 2020 to 2021, and now the clinic sees 45 to 50 non-chemo patients per week.
“Some patients don’t do well with pills and sometimes change to infusions based on side effects, disease progression and different lines of treatments,” Sturm said.
Street, who has lived in Steamboat since 2002 and now resides at Casey’s Pond, said she originally traveled to an arthritis clinic in the Denver area for her infusion treatments, so she is pleased to have the treatment available near home.
She hopes other patients will find pain and symptom relief as she has.
“If it will help even one person make that call, I’m glad that I was able to help,” Street said of her interview and photo for the Steamboat Pilot & Today.
To reach Suzie Romig, call 970-871-4205 or email sromig@SteamboatPilot.com.
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