Infusion room

At the Institute of Rheumatology we have an infusion room. Here's what you can expect when you come to receive an intravenous biologic agent. Inflectra, Orencia, Rituxan, Actemra and Benlysta are medicines that we give regularly.

We have a specialized team for these treatments. Josianne, Louise, Melanie and Sabrina are the nurses working in the infusion room.

 

The duration of an infusion depends on the biological agent that has been prescribed to you. It varies between 45 minutes and 6 hours.

Have you been prescribed intravenous biologic therapy? Here is the procedure.

You have been approved by your insurance or the RAMQ to receive your biological treatment.

Whether it is your first biological treatment or not, an exceptional medication form will be filled out by a nurse. She will also tell you everything you need to know before starting this new treatment. The document requesting the approval of the exception drug will explain the state of your illness and the trial of previous medications. It will be sent to your biologic patient support program. There is a support program for each of the biologic drugs. That program will provide you with financial assistance, as well as with information on the drug or allow you to receive your treatment at home, which is the case of the Orencia.

 

This program will send the exceptional medication form to your private insurer or to the RAMQ. At that time, your rheumatologist will have some tests done before starting you on the biological IV: PPD (test to detect tuberculosis), some vaccines like Pneumovax, Prevnar, Zostavax (if you are 50 years and older), hepatitis A and B (if you are travelling), etc. These vaccines can be received at the CLSC or at a travel clinic, sometimes for a fee, or for free like the PPD. Some blood tests specific to your treatment will also be requested before starting.

Usually, your insurer or the RAMQ sends you a letter indicating the date on which the coverage of your medication will end. It is important to verify this date, because before the end of the approval, we will need to send a renewal form to demonstrate that your treatment is effective. In order to do that, you’ll have to take all necessary blood tests requested by your rheumatologist and fill the computer questionnaire each time you visit the Institute of Rheumatology.

 

Private insurers pays a variable percentage of the cost of your treatment up to a maximum amount determined by your insurance plan. You will have to pay for the portion that is not covered by your insurance. That's where the drug support program can help you by evaluating the portion that will be paid. This is done on a case-by-case assessment. You must therefore talk to a claims specialist. Do not be embarrassed by this option; almost all patients treated with a biologic agent benefit from this form of financial assistance. If you are insured by the RAMQ, you will reach the maximum amount to pay per year when you get your treatment. For more information on RAMQ coverage, click here. (Find the link in English on the RAMQ web site).

You are ready to start your treatment.

A nurse will schedule your first appointment and make sure you understand the nature of your treatment and how the infusion works. Beforehand, the program will send the prescription for your biological treatment to the pharmacy of your choice. The majority of our customers use the pharmacy near the clinic because they can deliver your medicine the week before your appointment. This way, you are sure that your biological will be well preserved, as it must be kept at a temperature between 2 and 8 degrees Celsius. Some pharmacists also offer a delivery service so just ask them if it’s possible. If you want to carry your own medicine, the support program can send you a kit that allows you to do so under optimal conditions. 

 

Each treatment has its peculiarities. You may need to be premedicated before your treatment, by taking Tylenol at home just before leaving for the clinic or by getting some from the nurse just before starting your biologic agent.

At your appointments

Plan to arrive 10 to 15 minutes in advance so our administrative assistant can welcome you, weigh you and if necessary, ask you to fill out a questionnaire on the computer. Afterwards, the nurse will greet you in the infusion room and ask you some questions to make sure you can receive your treatment. She will ask you if there have been any changes in your health, if you have had infections or taken antibiotics since your last treatment, etc. Please note that all these steps will be repeated at each appointment. If you change some of your medications, even if it's not for arthritis, bring the name of any new treatment. This will ensure that everything is compatible and track the frequency of antibiotic intake.

If you have an infection, an injury, or a recent or planned surgery, the biological IV cannot be administered since it reduces the effectiveness of your immune system. In case of doubt, call your nurse before your appointment to avoid an unnecessary visit. When the infection is resolved, the wound or surgical wound healed, you can resume treatment.

The infusion

After answering those questions, the nurse or doctor will decide if you can receive your biological treatment. The nurse will take your blood pressure, your pulse and your temperature. These vital signs will be taken a few times during the infusion of the drug and at the end of the treatment. The nurse will prepare your medicine. Some biologics need to be diluted with sterile water and others are already diluted. Your medicine is then added to a bag of solute.

 

Thereafter your nurse will install an intravenous catheter, according to the rules of asepsis. The duration of treatment depends on your biological, as mentioned above.

 

Some people may have a reaction (such as a headache, tingling, itching, etc.) during treatment. In that case, the treatment will be stopped and an appropriate medication will be given depending on the symptoms. When the reaction disappears, treatment will resume. Before your next appointment, you might have to take premedication to avoid having another reaction. It is common to do so and that does not mean that you are allergic to your treatment.

 

Other side effects may be experienced at home such as increased fatigue, headaches, nausea, etc. If you suffer from any side effect, notify the nurse at your next appointment.

The frequency of treatments depends on the biological, since some have loading doses. It's the case with these medications:

  • Inflectra: weeks 0, 2, 6. Thereafter, the frequency of administration will be every 6 to 8 weeks;

  • Orencia (intravenous) and Benlysta: weeks 0, 2, 4 and every 4 weeks thereafter;

 

Others biologics do not have any loading doses.  It's the case with these medications :                                                                                                                    

  • Actemra (intravenous) which is given every 4 weeks;

  • Rituxan, which is a treatment that includes two infusions: the first on day 1 and the second on day 15 and subsequently, at least 6 months later. Depending on your diagnosis, the dose and frequency may vary.

 

We hope this information will be useful to you. See you in the infusion room!

 

1551, rue Ontario Est
Montréal (Québec)  H2L 1S6

 

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© 2016 Institut de Rhumatologie de Montréal

révision Septembre 2018.

L'IRM remercie Abbvie, Amgen, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi et UCB pour leur support.

Une réalisation