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Pharmacist Focused Strategies for Systemic Mastocytosis

CE

Systemic Mastocytosis: Pharmacist-Focused Strategies to Improve Outcomes

Pharmacists: 1.00 contact hour (0.1 CEUs)

Released: May 22, 2025

Expiration: May 21, 2026

Jonathan A. Bernstein
Jonathan A. Bernstein, MD
Ryan Haumschild
Ryan Haumschild, PharmD, MS, MBA, CPEL
CME/CE Information

Activity

Progress
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Course Completed

Patient Follow-up

Ryan Haumschild, PharmD, MS, MBA, CPEL:
So avapritinib was added to Sandy's medications, and she is doing better. Of note, Sandy has not filled her epinephrine autoinjector prescription because she thinks it is not something she needs with all of the other medications she has, and this is a reality for many patients.

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How often do you have difficulty providing patients with an epinephrine autoinjector they can afford and use easily?

Anaphylaxis Checklist for Pharmacists*

Ryan Haumschild, PharmD, MS, MBA, CPEL:
In transitioning into discussion of anaphylaxis, let’s consider this checklist for pharmacists. We have to ensure that we are dispensing the prescribed epinephrine device at the appropriate dose. Further, patients should have 2 devices on hand and be mindful of expiration dates. Patients also need an action plan and should carry their devices everywhere.

To do all of this, pharmacists must educate patients on how to use these devices and how to correctly store them to maintain the potency. Patients also need to understand that epinephrine, not an antihistamine, is the first-line treatment anaphylaxis. That means telling patients that if they are having anaphylaxis symptoms, they need to use the epinephrine and not simply take their H1 blocker in hopes that it will get better.27

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Patient Anaphylaxis Education

Ryan Haumschild, PharmD, MS, MBA, CPEL:
As part of anaphylaxis education, it is critical that patients have an action plan. They should know that anaphylaxis is common in their disease; 24% to 49% of patients with mast cell disorders experience anaphylaxis.28 Further, a survey found that 30% of patients with SM had 1 or more emergency department visits related to anaphylaxis, and 14% used their epinephrine ≥2 times in a year, which is significant.29 We should educate proactively, ensuring that patients have their epinephrine devices on hand and are prepared if an anaphylaxis event occurs.12

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Polypharmacy Is Common in Systemic Mastocytosis

Ryan Haumschild, PharmD, MS, MBA, CPEL:
Polypharmacy is also common in SM management, as patients often will be on different therapies like antihistamines and antidepressants. The majority of patients will receive >3 prescription medications at a time for SM management.29 Remember that in the patient case, Sandy did not think she needed the epinephrine because of all of her other medications.

So pharmacists should provide proper interprofessional communication and medication reconciliation to help ensure that other HCPs know exactly what patients are on; we need to do our due diligence in our review.30

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Including Patients in Discussions About Medications Can Reduce the Risk of Polypharmacy

Ryan Haumschild, PharmD, MS, MBA, CPEL:
We can reduce the risk of polypharmacy through shared decision-making and updating all medications, including those that are over the counter, as part of our assessment. In addition, new treatments can change the landscape significantly. For example, the PIONEER trial found that patients on avapritinib were more likely to reduce or discontinue symptom-directed treatments vs those on best supportive care.30,31

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Multidisciplinary Care Is Often Needed for Systemic Mastocytosis

Ryan Haumschild, PharmD, MS, MBA, CPEL:
Multidisciplinary care also is essential for managing SM.32 Pharmacists can help ensure that we are doing appropriate hand-offs. Further, the National Comprehensive Cancer Network guidelines recommend referrals to specialized centers. And we must make sure that we are reviewing these patients’ treatments as well as providing the appropriate therapy.12

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What approach(es) do you use for referring patients to specialists?

Key Takeaways

Ryan Haumschild, PharmD, MS, MBA, CPEL:
The key takeaways here are that it is critical that pharmacists partner with specialists, ensure that patients are getting the right referrals, do medication reconciliation to reduce polypharmacy, and educate patients. If you know a patient has SM, confirm that they have their epinephrine and that they understand the medications that they are receiving. It is always important to build a good rapport because this disease requires a team-based approach to care. This will set up patients to achieve success.

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