Category: Blog

04 Sep 2018

Eat to Calm Psoriasis

Most people with psoriasis will have some degree of symptoms for life. But this doesn’t mean that improvement can’t happen. Medications help keep this skin disease under control and combining medication with certain dietary choices can also have a positive effect on both psoriasis and psoriatic arthritis (which is a joint condition related to the skin disease).

The Medical Board of the National Psoriasis Foundation recently reviewed the current body of scientific research so they could share the latest understandings about how diet affects psoriasis and psoriatic arthritis. Their review included 55 studies – which covered more than 77,000 people both with and without psoriasis.

The biggest take-away from this National Psoriasis Foundation project relates to overweight or obese patients with psoriasis. It may not be the most popular news to hear, but the evidence shows that a low-calorie diet with the goal of losing weight leads to significant improvements in the severity of psoriasis symptoms, as well as (obviously) weight loss and an improved “dermatology quality of life.” Losing weight improves both skin and joint symptoms of psoriasis, which is why this dietary change earned the Medical Board’s strongest recommendation.

People with psoriasis are known to have a higher risk of also developing celiac disease, which is why gluten-free diets tend to be popular with psoriasis sufferers. According to this Medical Board, gluten-free diets have shown some benefit, but only in patients who test positive (based on a blood test) for gluten sensitivity. In these situations, a three-month trial of going gluten-free can make sense.

In terms of dietary supplements, the strongest evidence emerged for vitamin D supplements, but this recommendation was geared specifically to overweight/obese patients with psoriatic arthritis.

One final thing that’s important to keep in mind: all of these dietary changes are recommended to be done in combination with a medication plan of care – not in place of one.


Ford AR, Siegel M, Bagel J, et al. Dietary recommendations for adults with psoriasis or psoriatic arthritis from the medical board of the National Psoriasis Foundation: A systemic review. JAMA Dermatol 2018;154(8):934-50.

04 Sep 2018

Rheumatoid Arthritis Vs. The Scale

Carrying around extra pounds can increase the risk of developing rheumatoid arthritis – but the relationship between weight and this autoimmune disease actually isn’t as cut and dried as it first appears.

First, it should be acknowledged that as body fat and waist circumference goes up, so does the chance of rheumatoid arthritis. Upwards of two-thirds of people with rheumatoid arthritis are either overweight or obese. There is no getting around the fact that extra pounds are risky when it comes to rheumatoid arthritis development.

This obesity-RA relationship comes with a gender difference; specifically, the link shows stronger in women than in men. So for a woman at risk for rheumatoid arthritis down the road (due to family history, age, and/or smoking), losing weight can reduce the risk of disease development. Overall in the United States, the rates of obesity and rheumatoid arthritis continue to rise – which is certainly a public health concern.

Obesity creates several problems in rheumatoid arthritis:

  • Greater weight means more stress on disease-damaged joints.
  • Being overweight tends to make RA symptoms worse.
  • Medication might not work as well, particularly biologics and some DMARDs.

But this weight issue gets a little more interesting in people who already have rheumatoid arthritis. Being overweight helps in one way: higher weight links to a lower risk of mortality from rheumatoid arthritis. In other words, normal weight people die earlier from RA than those who carry extra pounds. This is known as the obesity paradox, in which being overweight correlates to living longer. Body mass index (BMI) of greater than 30 is the threshold where this benefit emerges in those with rheumatoid arthritis.

So what should patients take away from this? Maintaining a healthy BMI reduces the risk of rheumatoid arthritis. In addition there are benefits for achieving healthy weight in those with active RA, since medications tend to be more effective and the additional risk of osteoarthritis is lessened. Of course there are other health benefits of healthy BMI, such as heart health. Overall, the benefits of achieving a normal BMI continue to outweigh any negatives.


Linauskas A, Overvad K, Symmons D, et al. Body fat percentage, waist circumference and obesity as risk factors for rheumatoid arthritis – A Danish cohort study. Arth Care Res 2018 July 5 doi: 10.1002/acr.23694.

Dar L, Tiosano S, Watad A, et al. Are obesity and rheumatoid arthritis interrelated? Int J Clin Pract 2018;72(1). doi: 10.1111/ijcp.13045.

04 Sep 2018

The Latest Word in HCV Treatment

New guidelines for treating hepatitis C infections came out from the World Health Organization. These replace and update WHO’s 2016 recommendations. Certainly a lot has changed in just the past three years – all of it comes as great news for anyone carrying the hepatitis C virus (HCV).

The key take-away from these comprehensive new guidelines (all 108 pages of them!) center on one game-changing strong recommendation:

  • Hepatitis C treatment should be offered to all people age 12+ (except pregnant women) with chronic hepatitis C infection, regardless of their disease stage.

In other words, treatment should not be delayed until the disease causes more serious health consequences. Treat HCV early and treat everyone.

A second big change to HCV recommendations relates to selecting a treatment:

  • Direct-acting antivirals, which work on all six major genotypes of HCV, should be used.

Since these types of medications effectively treat all types of HCV, it is no longer necessary to spend time and money on genotyping the infection (which previously was used to select the best treatment). The new course of action sums up as: get tested and get treated with one of the new direct-acting antivirals that work on all major forms of HCV.

WHO set a goal to eliminate viral hepatitis by the year 2030. It’s a tall order, but one that would save millions of lives. To achieve this goal, 90% of people who are infected need to get diagnosed with this disease (you can’t treat it if you don’t know you have it!) and 80% of people with a diagnosis need to be treated. So let’s get to it!


World Health Organization. Guidelines for the Care and Treatment of Persons Diagnosed with Chronic Hepatitis C Virus Infection. July 2018.

04 Sep 2018

Psoriasis: Can Sleep Troubles be a Red Flag?

The calling card of psoriasis is uncomfortable skin symptoms, such as red patches of dry, cracked skin. However, the more researchers look into this disease, the more they discover that psoriasis affects many different areas of the body, beyond the skin. Conversely, health conditions affecting non-skin parts of the body may also affect the risk of psoriasis.

Specifically, several preliminary studies have noted a connection between people who have sleep apnea and an increased risk of later developing psoriasis. This has the potential to affect many people, since 18 million Americans experience sleep apnea. The latest research reported on this connection, in the Journal of Clinical Sleep Medicine, noted that those with psoriasis are four times more likely to experience sleep apnea, than people without psoriasis.

The apnea-psoriasis connection is thought to trace back to inflammation as the common denominator. The current theory is that sleep apnea increases levels of certain cytokines (inflammatory proteins), which in turns ups the chances of psoriasis in those who are predisposed to this condition.

It’s good practice for health practitioners who treat psoriasis to screen patients for sleep apnea. It’s very common for a sleep partner to be the first to note sleep apnea symptoms, since it often causes chronic snoring and paused breathing followed by a gasp or choking sound. What is amazing about all of this latest research is that getting screened and treated for sleep apnea may indirectly serve as a way to manage (or even prevent) psoriatic disease. In the meantime, know that BioPlus Specialty Pharmacy is here to serve patients and their doctor offices with the latest information and medications for psoriasis treatment.


Gupta MA, Gupta AK. Psoriasis is associated with a higher prevalence of obstructive sleep apnea and restless legs syndrome: A possible indication of autonomic activation in psoriasis. J Clin Sleep Med 2018;14(6):

Papadavid E, Dalamaga M, Vlami K, et al. Psoriasis is associated with risk of obstructive sleep apnea independently from metabolic parameters and other comorbidities: a large hospital-based case-control study. Sleep Breath 2017;21(4):949-958.

04 Sep 2018

Pregnancy and Hepatitis C

Hepatitis C and pregnancy have a complicated relationship. Pregnancy itself does not appear to worsen the course of hepatitis C infection and a woman should wait to be treated for the infection until after pregnancy. Of course, there is understandable concern of how a hepatitis C infection in a woman can affect her unborn child.

Ideally, any woman who has risk factors for hepatitis C infection (e.g., exposure to contaminated needles or injected drug use) would be screened for hepatitis C prior to or at least during the pregnancy. Many experts are now calling for universal screening of pregnant women, regardless of reported risk factors.

Overall, for every 100 pregnant women with hepatitis C, 6 of their babies will be born also infected with this disease. The chance that a pregnant woman will pass on the hepatitis C virus to her unborn child depends on how high the viral levels are in her body, along with whether or not she is also HIV-positive (which makes it more likely). In any event, a pregnant woman with hepatitis C should be under the care of a specialist who can keep a close eye on liver function tests throughout the pregnancy. And during the birth itself there are recommendations to minimize risk of vertical transmission, such as avoiding scalp monitors (which could cause bleeding). Interestingly, there is not a risk of transmission from breastfeeding.

After a baby is born to an infected mother, the child should be tested at the age of 18 months for hepatitis C. About 40% of exposed children will clear the virus on their own without treatment, while the rest will require medication to treat the hepatitis C infection. However, this treatment should not start until age 3 and there are now (fortunately) medications that can be used at these young ages. For the mother, she should be treated after —  not during – the pregnancy.


Dibba P, Cholankeril R, Li AA, et al. Hepatitis C in pregnancy. Diseases 2018;6(2):E31.

Cervino L, Hynicka LM. Direct-acting antivirals to prevent vertical transmission of viral hepatitis C: When is the optimal time to treat? Ann Pharmacother April 1, 2018 doi: 10.1177/1060028018772181

04 Sep 2018

Psoriatic Arthritis: Current Understandings

Doctors, as far back as the mid-19th century, noticed the connections between psoriasis and arthritis that occurred in some of their patients. However, this condition of “psoriatic arthritis” did not receive a clinical definition until the 1960s, when it was distinguished from rheumatoid arthritis.

Part of the difficulty with understanding psoriatic arthritis relates to a lack of specific biologic tests to diagnose this disease. Although it is known that psoriatic arthritis develops in about 5% of those with psoriasis, with the skin condition generally appearing before joint involvement.

Management of psoriatic arthritis often starts with NSAIDs and disease-modifying antirheumatic drugs (DMARDs), including methotrexate, sulfasalazine, cyclosporine, leflunomide, and biologic agents.

More recently, new and more effective biologics and small-molecular medications are becoming available which target specific cytokines and signaling pathways involved in this disease. This has meant a slowing of disease progression and improved quality of life for more patients than ever before. However, there remain at least 40% of patients who only have a partial response to current medications or no response at all.

This all serves to highlight that while much progress has been made with psoriatic arthritis, there is still a long way yet to go. Clinical trials are currently finding promising results with the medications tofacitinib, ixekizumab, and guselkumab. Hopefully more (and more effective) options will be available to psoriatic arthritis patients in the near future.

BioPlus Specialty Pharmacy has a team of pharmacists, patient care coordinators, and a financial assistance department who are all ready to help you with your doctor’s treatment plan. To access more helpful information about the chronic condition of psoriatic arthritis, check out BioPlus Health.


Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. Lancet June 2, 2018 DOI:

Psoriatic arthritis: classification and holistic management. Lancet June 2, 2018 DOI:

04 Sep 2018

Get Moving! (Yes, Even if You Have Cancer)

Exercise does a body good. In terms of cancer, there is already a substantial amount of evidence that staying active reduces the risk of developing cancer, including colon, breast, and endometrial cancers. Now, experts are excited about the connection between exercise and better outcomes for people who have been diagnosed with cancer.

For the first time, a major cancer organization – The Clinical Oncology Society of Australia – came out with exercise guidelines for cancer patients. The guidelines are sweeping: they recommend exercise to be part of a cancer treatment plan for ALL cancer patients. In short: exercise should be prescribed to anyone battling cancer.

The evidence backing up this ‘exercise prescription’ is based on studies showing better quality of life, energy, weight, and mental health in patients who find ways to stay active. The specifics of this exercise directive call for working toward a goal of:

  • 150+ minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity aerobic exercise each week. This can include walking, jogging, cycling, swimming, or other activity that raises the heart rate.
  • 2-3 sessions each week of resistance exercise.

It’s important to start slowly and ramp up as feels tolerable to a person. These are the guidelines and goals; of course, this plan should be tailored to fit each person’s situation (e.g., abilities, treatment-related adverse effects, anticipated disease trajectory, and health status).

The big take-away here is the radical shift from the advice for cancer patients to simply rest and avoid activity; rather the new advice is to stay as active as possible, even during the treatment process. So let’s all get moving, today!

04 Sep 2018

Latest Guidelines for MS Treatment

Evidence-based medicine calls for ongoing research and refinement of best practices for treating various diseases. In this spirit, a multi-disciplinary panel recently convened to develop recommendations for disease-modifying therapy for those with multiple sclerosis.

This panel certainly was busy, in all they developed 30 recommendations; 17 of which related to when/how to start on disease-modifying therapy (DMT), 10 related to switching DMTs in cases of disease progression, and the final 3 were about stopping DMTs. The panel presented these guidelines at the 2018 American Academy of Neurology Annual Meeting and then published them in Neurology.

First things first: disease-modifying therapies are a key part of MS treatment and are the best current strategy to slow the course of this disease. There are now approximately 17 medications in this category and they include medications that are injected (e.g., Copaxone and Zinbryta), infused (e.g., Lemtrada and Ocrevus), and taken orally (e.g., Gilenya and Tecfidera). None of these can cure MS but they do each have a proven record of effectiveness in controlling the disease. However, a medication that currently works for a patient may not work in the future, which is why medications sometimes need to be changed.

The following are some are the highlights about DMT use from this panel’s recommendations:

The earlier treatment for MS starts, the better the chances are for altering the disease course. Starting treatment sooner generally means fewer relapses and lessens the injuries to the brain.
Newly diagnosed patients do better when they hear their treatment options at a dedicated treatment visit. This is because patients can have trouble processing the large amount of new information at a diagnosis appointment.
It’s important to take patient preference into account regarding the different options of medications (cost, route of administration, safety, and so on).
Health care providers should take care to counsel patients about realistic expectations of what DMTs can achieve in treatment.
It’s important to continue monitoring patients on DMTs in terms of adherence, side effects, and safety.
Reproductive plans are an important part of the discussion with patients (e.g., male infertility and risks of DMT use in pregnancy).
Monitoring of disease activity (in terms of new lesions and relapses) can inform the decision to change DMTs. If a medication switch is warranted, consider changing to a medication with a different mechanism or efficacy profile as well as to a medication that is taken through a different route (injection vs. infusion vs oral).
If a patient discontinues taking DMT medications, counseling about the likelihood of relapse is important.
Cost can be a huge barrier to patients when accessing treatment. Providers should also guide patients in need to financial assistance sources.
Overcoming financial challenges is one of the ways BioPlus Specialty Pharmacy supports our patients, including those on medications for multiple sclerosis. Our patient financial assistance department works to ensure that financial barriers are overcome so patient treatment can both start and continue.


Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline: disease-modifying therapies for adults with multiple sclerosis. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Presented at: 2018 American Academy of Neurology Annual Meeting. April 21-27, 2018; Los Angeles, CA.

Ciccone A. Multiple sclerosis guidelines: AAN’s recommendations for initiating, switching, stopping disease-modifying therapy. Neurol Adv April 23, 2018.

12 Jun 2018

Skip the Chemo?

Breast cancer treatments have made impressive strides in terms of increasing survival rates for patients; however, a huge new study reveals that chemotherapy may not be as important of a factor for some women with breast cancer as previously thought. In fact, in some categories of breast cancer, most patients who received chemotherapy may not have actually benefitted from it. In other words, these patients would have survived just as well without the addition of chemotherapy.

This new research, which was discussed at the American Society of Clinical Oncology and published in the New England Journal of Medicine, could lead to an overhaul of the decision making process, as experts rely on better research-based guidelines to decide which patients should (and which shouldn’t) have chemotherapy added to their plan of care.

Chemotherapy generally brings painful side effects for patients, although those can certainly be worth it if life is extended. In a decade-long study of more than 10,000 women with breast cancer, there was no benefit of chemotherapy for patients with the most common type of breast cancer. Specifically, this common type of breast cancer is characterized as hormone-receptor–positive, HER2-negative, axillary node–negative breast cancer with a midrange 21-gene recurrence score. Women with this most common breast cancer did not garner benefits from chemotherapy, as opposed to surgery and hormone therapy. (There were exceptions; however, for some younger women and some women older than age 50.)

What Does This All Really Mean?

Up to 70% of women with the most common type of breast cancer don’t need chemotherapy (which means these women can also skip the nausea, hair loss, and anemia that chemotherapy generally brings with it).

This new study adds to our understanding of breast cancer treatment and continues to create a clearer picture of how to personalize treatment based on each individual’s specific tumor qualities.

The take-away is this: each year in the U.S. there are now 70,000 women with breast cancer who might be able to skip chemotherapy and still have the same chance of beating this disease. Of course, it’s best for patients to discuss with their oncologists about what is the best course of treatment for their specific situation.


Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. New Engl J Med June 3, 2018 DOI: 10.1056/NEJMoa1804710

05 Jun 2018

New Hope in Ulcerative Colitis

Xeljanz (tofacitinib) garnered a lot of interest back in 2012 when it was developed and approved for the treatment of rheumatoid arthritis. Then, in 2017, studies found that this oral medication also treated psoriatic arthritis and FDA approval was added for that indication.

Last week, yet another FDA approval for Xeljanz came: this medication now has an expanded FDA approval for adults with moderately to severely active ulcerative colitis. This makes Xeljanz the first oral prescription option for ulcerative colitis. In other words, this is big news and a potential game changer for the nearly one million Americans with this form of inflammatory bowel disease. All of the other FDA-approved treatments for chronic ulcerative colitis involve either intravenous infusion or subcutaneous injection. So, clearly, an oral alternative is welcome news to many patients.

This latest FDA approval was spurred after results from three clinical trials in patients with ulcerative colitis showed remission for patients on Xeljanz in up to 47% of patients taking the medication long term. Safety data was collected, with the more common adverse effects being diarrhea, elevated cholesterol levels, and headache. Although there are some less common adverse effects that led to Xeljanz coming with a box warning for serious infections and malignancy. Xeljanz cannot be used at the same time as biological therapies or with potent immunosuppressants (e.g., azathioprine and cyclosporine).

Inflammatory bowel diseases, which include both ulcerative colitis and Crohn’s disease, are chronic inflammatory diseases of the bowel. They can develop as a result of genetic or environmental factors (e.g., smoking, diet, or any alteration of the normal human gut flora) that trigger an immune response, which in turn creates mucosal damage to the GI tract.

Symptoms of inflammatory bowel disease range from diarrhea, abdominal pain, and perianal fistulas to fatigue, weight loss, and/or bowel obstruction. While ulcerative colitis is more closely associated with changes to the inner lining of the colon, Crohn’s disease can affect any segment of the gastrointestinal tract: all the way from mouth to anus.

The BioPlus Specialty Pharmacy team is ready to help patients and their health care providers access Xeljanz for ulcerative colitis.


Press release. FDA approves new treatment for moderately to severely active ulcerative colitis. FDA May 30, 2018.