What to Know About Telehealth and Biologics

Especially in light of the COVID-19 pandemic, the shape of how care is delivered has been transformed by the advent of telehealth. The use of remote, video teleconferencing, apps, and other technologies has made appointments more accessible, bringing healthcare providers to living rooms and specialists to remote areas. It’s a game-changer, too, for those taking biologics—a class of drugs used for a wide range of inflammatory, allergic, and autoimmune conditions.

Defined as drugs derived from natural sources, such as living cells or tissues, biologics like Humira (adalimumab), Dupixent (dupilumab), and Rituxan (rituximab) take on a wide range of conditions. Most commonly, they’re prescribed for rheumatoid and psoriatic arthritis, ankylosing spondylitis, as well as conditions like asthma, psoriasis, and rhinosinusitis. Other types treat cancer and macular degeneration.

In the same way that more and more people are prescribed biologics, the use of telehealth is on the rise. Spurred by the pandemic, by April 2020, 69% of total healthcare visits occurred remotely. Understanding how this technology is used, what appointments are like, and where it’s headed is essential if you’re taking or may have to take biologics.

What Do Biologics Treat?

In many of their applications, biologics aren’t often the first line of treatment. Because they have an immunosuppressive effect—meaning they slow down or stop your body’s immune response—there’s an increased risk of developing bacterial or viral infection while taking them. However, what sets them apart from other similarly acting drugs is that they can often more precisely target specific antibodies regulating immune function.

Most commonly they’re indicated for:

• Arthritis: Autoimmune disorders can cause the immune system to attack and damage the joints, causing inflammation, swelling, and pain. Rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis (arthritis due to psoriasis), among others, can all be treated by a class of biologics called “tumor necrosis factor (TNF) blockers.” Humira, Cimzia (certolizumab pegol), and others are injected into affected areas.
• Chronic rhinosinusitis: This chronic infection of the upper airways can lead to the formation of nasal polyps, which are growths in the inner lining of the sinuses. The biologic, Dupixent (dupilumab), among others, is indicated when initial treatments don’t yield results.  
• Inflammatory bowel diseases: Ulcerative colitis and Crohn’s disease, an autoimmune disorder, cause inflammation in the colon and intestine. TNF inhibitors may be attempted to treat these in cases where standard therapies don’t work.
• Dermatological conditions: Plaque psoriasis is among the skin conditions treated topically with biologics, such as Humira and Enbrel (etanercept), among others. These are typically administered subcutaneously, via injection to the tissues just below the skin.
• Asthma: Cases of hard-to-manage asthma, marked by spasms and breathing difficulties, can be managed with Xolair (omalizumab), Nucala (mepolizumab), and Dupixent, among others. This condition is triggered by exposure to allergens or irritants in the air and arises in some who’ve had viral infections as infants.
• Cancer: Some types of biologics, like interleukins (molecules produced by the body) and monoclonal antibodies (cloned by substances produced by white blood cells), can play a role in the treatment of a range of cancers, including non-Hodgkin lymphoma and breast cancer. These medications spur your body to go after aggressive cancer cells.
• Macular degeneration: Ophthalmologists treat age-related or diabetes-related loss of visual acuity by injection of aflibercept, Lucentis (ranibizumab) and Avastin, and others directly to the retina of the eye.
• Eosinophilic esophagitis (EoE): This chronic inflammatory condition occurs when eosinophils (white blood cells) are found in the inner lining of the esophagus, causing inflammation. Dupixent is the first and only EoE treatment approved by the Food and Drug Administration (FDA).
  

Notably, insulin (which is often prescribed for diabetes) has recently been redefined as a biologic drug by the FDA).

Telehealth and Biologics

What Is Telehealth?

When most people think of “telehealth,” they picture appointments being conducted online—an important component—but there’s more to it than just that:

• Virtual visits let you see your practitioner or a specialist located anywhere in the world using video teleconferencing.
• Remote monitoring using apps or devices allows healthcare providers to check metrics, such as heart rate, remotely.  
• Reminders via phone call, text, or email help remind you of appointments or prescriptions.
• Patient education is also available in the form of videos, such as instructions on how to use an inhaler or to explain information about your condition.  

When Is Telehealth Used?

While there are some things that can only happen in face-to-face appointments, telehealth has established itself as an excellent means for many aspects of care. For those who may need biologics or have already had this kind of therapy, remote appointments can be used to:

• Provide follow-up care: Virtual visits may be used following injections of TNF inhibitors for arthritis, or to check in if any issues arise as you manage your asthma, sinusitis, or other condition.
• Assess prescription efficacy: You may be prescribed biologics or other therapies during an online appointment, and you may have consultations remotely about how your medications are working for you.
• Accommodate your schedule: As appointments may be conducted when the office is closed, or can even be fit in during a break from work or school, telehealth may be the only option if you’re very busy or if mobility is difficult.
• Provide urgent care: As visual assessment along with an assessment of symptoms can be enough for diagnosis of psoriasis, as well as other skin conditions, biologics may be diagnosed remotely. Care for conditions like sinusitis, among others, can also be performed using telehealth.
• Consult a specialist: Access to specialists who may not be in your area can be beneficial to those living in more rural areas.

The limitations, of course, are that certain kinds of tests and assessments, not to mention treatments, can only be performed in the clinic or hospital. Additionally, some tests are required prior to the prescription of some biologics because of their immunosuppressive nature.

How to Prepare for Your Telehealth Visit

Though telehealth appointments are, by nature, convenient, there’s still a little preparation involved to ensure the virtual visit goes smoothly. Here’s what you should keep in mind:

• Get a good picture: Aim for the best quality video you can, whether it be using a camera, your laptop, a tablet, or even your phone.
• Test your setup: Try to test your camera and microphone setup to ensure they’re working properly. Most laptops, headphones, and devices have built-in microphones and cameras; make sure the telehealth software your healthcare provider is using allows you to access them.
• Assess your connection: Make sure you’re in a place that has good connectivity for your appointment; technical difficulties can be frustrating in a virtual visit. If you’re at home, you may want to ask family members to spare bandwidth for the appointment.
• Charge your device: Make sure whatever device you’re using—be it a computer or a phone—is charged for the appointment.
• Find a nice space: A comfortable, well-lit space is needed for your virtual visit. You also will want to make sure you’re in a quiet place, and there are no distractions.
• Frame the shot: Ideally, the video image you want to present should show your head and shoulders.
• Bring questions and information: Have a list of medications you’re taking, as well as herbs and supplements, on hand for your healthcare provider. It’s a good idea to prepare questions to ask about your condition or treatment, and, of course, share any concerns.
• Have an interpreter: If you or a loved one foresees problems communicating, make sure to have someone around who can help translate.

Questions to Ask Your Provider

As a patient, the key is to get the most out of the visit; the time with your healthcare provider or a specialist is yours to learn and gain insight from. Be open about your condition, and don’t hold back on any concerns you may have.

What are some questions you should ask? Here’s a quick breakdown:

• What are the most important things I need to understand about my condition?
• What sorts of additional tests or treatments do I need?
• What side effects are there with the biologics or other drugs I’m taking?
• What can I do at home to help manage my condition?
• What are the risks and benefits of the treatment options?
• What sort of lifestyle adjustments, if any, are needed for my medication?
• What safety information do I need to know about my medication?

Benefits and Challenges

While overall telehealth use may dip from the heights they reached during the peak of the COVID-19 pandemic, the technology has not only proven its utility, it has won over most patients. According to the National Organization of Rare Disorders (NORD), 92% of those that had a virtual visit rated it a positive experience. There’s a lot to be said about the way that technology can deliver health care to your home directly.

Certainly, though, there are limitations with this technology; not only are certain assessments or treatments not possible, many people prefer face-to-face interaction. That said, this technology also empowers patients by removing burdensome commutes. It’s revolutionized the care of those facing chronic conditions and made care more accessible than ever.

Telehealth has cemented its place in the care of those suffering with autoimmune disorders, arthritis, and many other patients using biologics. The technology that makes it possible has developed exponentially in the face of the pandemic. It will no doubt continue to do so.

A Word From Verywell

Whether you’re suffering from psoriasis, asthma, arthritis, or any other condition treated with biologic drugs, the outlook is rosier with the advent of telehealth. Advances in technology, having not only changed medical techniques and approaches, have transformed the nature of how care is delivered.

What telehealth opens up, ultimately, is even more access to what your healthcare provider and specialists can offer. It can help remind you to stay on top of care, be a portal for information, and give you extra footing to take on your condition.