EDITORIAL:
Congratulations to the Real Pharmacists of the Class of 2020
at Their Virtual Commencement!
I extend my congratulations on this occasion of the celebration of the awarding of your Doctor of Pharmacy degree. Your dedication, abilities, perseverance, and accomplishments are a source of great enjoyment, encouragement, and inspiration for your families, friends, and members of your college/school of Pharmacy community, and we know your commencement is a very fulfilling experience for you. You are well prepared to excel in your future responsibilities!
Until my retirement from my faculty position at the Philadelphia College of Pharmacy/University of the Sciences in 2018, one of my responsibilities was to serve as the faculty advisor for the organizations of Christian students on campus. I also coordinated the arrangements for the Baccalaureate service that has been held on the morning of Commencement, and have often been the speaker at this service. Because of the COVID-19 pandemic, this service will not be held this year and there will be a virtual Commencement. Therefore, I am combining some faith-based observations in this message, along with perspectives and suggestions based on my experiences that I hope will be of value for you.
"Now faith is being sure of what we hope for and certain of what we do not see. This is what the ancients were commended for. By faith we understand that the universe was formed at God's command, so that what is seen was not made out of what was visible." The Bible: Hebrews 11: 1-3.
"Love the Lord your God with all your heart and with all your soul and with all your mind. This is the first and greatest commandment. And the second is like it. Love your neighbor as yourself." The Bible: Matthew 22: 37-38.
From my experiences, I am sharing the following perspectives and suggestions for you to consider:
Identify your personal and professional priorities and goals with respect to your responsibilities and actions. I suggest the following priorities to start:
- Faith;
- Family (Love and honor your parents, and your future [or present] spouse and children.);
- Friends and colleagues;
- Personal and professional development;
- Our profession of Pharmacy
Focus on identifying, further enhancing, and refining your personal qualities, including:
- Integrity;
- Caring, empathy, compassion (People don't care how much you know until they know how much you care!);
- Valuing ethical, moral, and legal standards;
- Principles and advocacy (Those who value privileges above principles soon lose both.);
- Respect;
- Enthusiasm and passion for your responsibilities;
- Strong work ethic;
- Interpersonal skills and relationships;
- Communication skills;
- Leadership;
- Courage in voicing your concerns, opinions, and recommendations.
Stay/Be involved in:
- Your church, synagogue, mosque, or other place of worship;
- Pharmacy organizations;
- Volunteer services;
- Civic responsibilities;
- Your Alumni Association and alma mater.
Make a commitment to life-long learning and intellectual stimulation by valuing:
- The expertise, experience, and perspectives of others (including individuals with opinions that may be different from your own);
- The joy of learning (that you may not have experienced to date because of the pressure of schedules of courses and other responsibilities, as well as exam anxiety);
- Reading for pleasure (e.g., books);
- Staying current in the news (I suggest The Wall Street Journal and a local newspaper);
- History (Those who ignore history are destined to repeat it.);
- Continuing professional education;
- Curiosity (e.g., that results in understanding that goes beyond knowing facts);
- Setting aside time for creative thinking and imagination;
- Common sense;
- Reasoning.
Be generous and charitable with your time, expertise, and resources.
I have often advised students of the importance of their cover letter in applying for employment and other opportunities. A resume or curriculum vitae is of value in informing the recipient of your interests, experiences, accomplishments, and honors. However, your cover letter provides the opportunity to tell the recipient "who you are" with respect to your personal qualities, priorities, and strengths you will bring to the opportunity for which you are applying.
As you are now recognized for the successful completion of your degree requirements and are awarded your diploma, you are on the pinnacle or mountain top of accomplishment. However, because of the COVID-19 pandemic, in-person Commencement and large celebrations are canceled, and many are in a valley of restrictions, isolation, and even fear and despair. There is hope in the words of one of my favorite songs, God on the Mountain (written by Tracy Dartt).
Life is easy, when you're up on the mountain
And you've got peace of mind, like you've never known
But things change when you're down in the valley
Don't lose faith, for you're never alone
For the God on the mountain is the God in the valley
When things go wrong, He'll make them right
And the God of the good times
Is still God in the bad times
The God of the day is still God in the night.
We talk of faith way up on the mountain
Talk comes so easy when life's at its best
Now down in the valleys, of trials and temptations
That's where your faith is really put to the test
For the God on the mountain is the God in the valley
When things go wrong, he'll make them right
And the God of the good times
Is still God in the bad times
The God of the day is still God in the night.
Stay strong and you will make a difference! Congratulations and best wishes for good health and happiness in your future responsibilities!
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NEW DRUG REVIEW:
Upadacitinib
(Rinvoq – AbbVie)
Antiarthritic Agent
New Drug Comparison Rating (NDCR) = 3
(no or minor advantages/disadvantages)
in a scale of 1 to 5, with 5 being the highest rating
Indication:
Treatment of adults with moderately or severely active rheumatoid arthritis who have had an inadequate response or intolerance to methotrexate.
Comparable drug:
Tofacitinib (Xeljanz, Xeljanz XR), baricitinib (Olumiant).
Advantages:
- Labeled indication for rheumatoid arthritis is broader (compared with baricitinib that is indicated for patients who have had an inadequate response to one or more tumor necrosis factor [TNF] inhibitor therapies);
- May be used in patients with moderate or severe renal impairment without dosage adjustment (whereas the use of baricitinib is not recommended, and tofacitinib should be used in a reduced dosage);
- May be used in patients with moderate hepatic impairment without dosage adjustment (compared with tofacitinib with which the dosage should be reduced);
- May be used in patients also receiving a CYP3A4 inhibitor without dosage reduction (compared with tofacitinib with which the dosage should be reduced).
Disadvantages:
- Labeled indications are more limited (compared with tofacitinib that is also indicated in patients with psoriatic arthritis or ulcerative colitis);
- Interacts with more medications (compared with baricitinib);
- Dosage adjustment flexibility is limited (compared with tofacitinib that is available in immediate-release and extended-release tablet formulations).
Most important risks/adverse events:
Serious infections (boxed warning; treatment should not be initiated in patients with an active serious infection; patients should be evaluated for active or latent tuberculosis infection; should not be used concurrently with another Janus kinase inhibitor, a biologic disease-modifying antirheumatic drug [DMARD; e.g., TNF inhibitors], or a potent immunosuppressant [e.g., azathioprine, cyclosporine]; live vaccines should not be used concurrently); lymphoma or other malignancies (boxed warning); thrombosis, including deep vein thrombosis, pulmonary embolism, arterial thrombosis (boxed warning); gastrointestinal perforation (caution should be exercised in patients at increased risk [e.g., a history of diverticulitis]); laboratory abnormalities (neutropenia, lymphopenia, anemia; treatment should not be initiated, or should be interrupted, in patients with an absolute neutrophil count less than 1000 cells/mm³, an absolute lymphocyte count less than 500 cells/mm³, or hemoglobin less than 8 grams/dL); elevated liver enzymes and lipid concentrations; risk if used during pregnancy (effective contraception should be used); women with infants should not breastfeed; action may be reduced by strong CYP3A4 inducers (e.g., rifampin) and concurrent use is not recommended; action may be increased by concurrent use of a strong CYP3A4 inhibitor); use in patients with severe hepatic impairment is not recommended.
Most common adverse events:
Upper respiratory tract infection (14%), nausea (4%), cough (2%), pyrexia (1%).
Usual dosage:
15 mg once a day.
Products:
Extended-release tablets – 15 mg (should not be split, crushed, or chewed).
Comments:
Upadacitinib is the third Janus kinase (JAK) inhibitor to be approved for the treatment of patients with rheumatoid arthritis, joining tofacitinib and baricitinib. It may be used as monotherapy or with methotrexate or another nonbiologic DMARD. Its effectiveness was primarily evaluated in studies in which the primary endpoint was the proportion of patients who achieved an ACR20 response (i.e., a 20% improvement in criteria established by the American College of Rheumatology) at 12 weeks. Studies included patients who had an inadequate response to methotrexate, and patients who had an inadequate response or intolerance to biologic DMARDs (e.g., TNF inhibitors). A significantly larger number of patients treated with upacitinib had higher ACR20, ACR50, and ACR70 responses, as well as clinical remission and inhibited radiographic progression.
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