Wednesday, 16 Jan 2019

You are here

Problems with Biologic Drug Storage

Is your patient’s refrigerator the problem with the inefficacy of biologic therapies? 

Biologics agents as adalimumab, golimumab and ustekinumab should be stored at a temperature of 2–8°C.  Several studies have identified a prevalent problem of unacceptable refrigeration storage of biologics used to treat immune mediated inflammatory disorders such as rheumatoid arthritis, psoriasis and inflammatory bowel disease.

de Jong and colleagues from the Netherlands studied 50 patients receiving golimumab packaged with a temperature sensor that recorded sample temperature every 5 minutes. Patients were told to store their medication as usual. Temperature deviations were defined as any duration below 0°C and >30 minutes below 2°C or above 8°C. 

After 3 months, data from 276 injectors and nearly 2.5 million temperature assessments showed that only one in eight (11.6%) were stored within the recommended temperature range. In addition, 11.2% were stored >30 minutes below 0°C and 33.2% were stored > 1 week above 8°C.  The authors suggested these findings may affect drug effectiveness in IMID-patients.

In 2016 Vlieland et al performed a similar observational study of Dutch patients given biologics with a temperature sensor. A majority (87.0%) of patients returned their temperature recordings to the pharmacy.

Only 6.7% stored their biologic within the recommended temperature range. Over 24% were guilty of storing their drug for more than 2 hours below 0°C  (median duration 3.7 h) and 2% stored drug at temperatures above 25°C (median duration 11.8 h).  (Citation source: https://buff.ly/2DoDQ34)

An editorial by Rentsch et al in the Journal of Gasteroenterology and Hepatology points out that none of these investigators studied the clinical impact of these missteps in drug storage. (Citation source https://buff.ly/2rsxkGU)

Thus it is unknown if the efficacy, viability, bioavailability or even the immunogenicity of these agents would be altered under these temperature variations.  Changes in the complex protein structure of biologics may result from freeze–thawing or prolonged storage at elevated temperatures and may lead to denaturation, irreversible formation of protein aggregates and loss of biological activity.  

Recommendations:

  • Store biologics at 2-8 ºC;  when taken out of the refrigerator should be kept at room temperature less than 25ºC
  • Studies have shown that etanercept may be safely stored at room temperature conditions of 25°C±2°C (77°F) for up to 1 month https://t.co/HMf7pcVudE
  • I advise patients who are traveling to either: A) take their biologic a few days earlier or later to avoid traveling with drug; or B) if they travel with a biologic they keep it cool, dark and dry. Remove from the refrigerator, wrap the injectable syringe in bubble wrap or light insulation (no need for an ice chest or dry ice), put it in a purse or briefcase and bring the box label. The syringe is safe on planes & hotels as long as they are at room temperature, away from sunlight or heat.  http://rheumnow.com/blog/tips-arthritis-travelers-best-2015-3
  • Discard drugs that have been frozen or improperly storage (call pharmacy or manufacturer for a replacement)
  • Pharmacists and nurses must counsel patients on the importance of storage conditions
  • There are companies developing apps to monitor drug temperature and usability. https://buff.ly/2rsHJ5v
  • Manufacturers should develop and incorporate temperature-sensitive warning devices that can be incorporated into packaging.
  • Tell patients to avoid storing Biologics in lower CRISPER Drawers, were the temperature is always lower (usually below  2°C or below 36° F). The lower temperature in the Crisper is optimal for storing produce and meats. 

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Best of 2018: The Safety of Paternal Exposure to DMARDs and Biologics

Pregnancy and drug safety is a complex issue, often with limited information about maternal drug exposure on the offspring. Greater uncertainty exists when considering whether paternal exposure may also influence fetal outcomes.

A systematic review examined the effect of disease modifying anti-rheumatic drugs (DMARDs) on male fertility and if peri-conception (within 3 months) paternal exposure was detrimental to fetal outcomes.

Best of 2018: Hydroxychloroquine Being Over-Dosed with New Guidelines?

Hydroxychloroquine retinopathy prevention guidelines have revised from ideal body weight-based dosing to actual body weight-based dosing; the question remains whether these have been adopted in clinical practice. A database of nearly 21,000 new HCQ users from a UK general population database studied HCQ dosing and use between 2007 and 2016. Specifically they examined whether users were subjected to excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW).

CDC Top 15 Most Common Opioid Overdose Drugs

The Dec. 12 issue of the National Vital Statistics Reports from the U.S. Centers for Disease Control and Prevention reports that the most commonly abused drugs causing drug overdose deaths (between 2011-2016) include fentanyl, heroin, oxycodone, and cocaine.

Trazodone High Risk of Falls and Fractures

The CMAJ (Canadian Medical Association Journal) has reported that trazadone use in the elderly may be associated with a risk of falls and major fractures. 

Using claims data from ICES, researchers compared 6588 seniors given trazadone to 2875 receiving another atypical antipsychotic.

Musculoskeletal Events with Statin Use

Analysis of the FDA Adverse Event Reporting System data examined the association between statins' musculoskeletal adverse events (MAEs).

Review of the data shows that atorvastatin and rosuvastatin (with strong low‐density lipoprotein cholesterol‐lowering effects) had a higher risk and a faster onset of MAEs when compared with simvastatin.

They could not detect whether concomitant drugs shifted the onset timing of MAEs.