Zilretta?

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ctts

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Just curious if any one is using Zilretta (extended release triamcinolone)? If so, are you using it for the knee only, or for other areas? ESIs? Your thoughts on this? I have not used it, but rep has come by a couple times. I hear the ortho group in my area is using it.
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The package insert specifically mentions not to be used epidural. It would be indefensible if there were a complication.
 
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ctts said:
Just curious if any one is using Zilretta (extended release triamcinolone)? If so, are you using it for the knee only, or for other areas? ESIs? Your thoughts on this? I have not used it, but rep has come by a couple times. I hear the ortho group in my area is using it.
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Is the ortho group concerned about chondrotoxicity?
 
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i dont see much of a space for zilretta right now.

if the effects are CLEARLY better than kenalog, i might try it, but the hassle of mixing it up, etc, is probably not worth it. 20610 gets pain the same whether you use zilretta or kenalog.

if viscosupplementation cant be approved, then i may use it in the knee. nowhere near the spine, tho
 
We use it. I see no difference between it or Depo.
 
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It “works” to pad the ancillary revenue stream...
 
I would like to see the evidence that it doesn’t elevate blood sugars.

I would think cortisol suppression would be longer?
 
I used for my first time last week. The patient wanted it and so we did, I am interested to see how it compares. It is crazy expensive..........
Is there something I missed on this with chondrotoxicity?
 
Bunch of comments here without any real substance. They did studies comparing Zilretta vs regular steroid. Effects were longer, less steroid levels in the blood, less blood sugar spikes, and measurable levels of steroid in synovial fluid weeks after the injection vs none with traditional steroid. The medication is more expensive, somewhere in the $500-600 range, but is billed with a J code and reimbursed by Medicare as well as nearly every other insurance in Oklahoma. We make a $31 profit when using Zilretta over costs with what insurance pays, hardly what most would call padding the ancillary income. Dose the increased cost of the drug make it worth the extra weeks worth of pain relief, maybe. Nearly every Ortho group in town is using this regularly for what it’s worth.
 
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gdub25 said:
Bunch of comments here without any real substance. They did studies comparing Zilretta vs regular steroid. Effects were longer, less steroid levels in the blood, less blood sugar spikes, and measurable levels of steroid in synovial fluid weeks after the injection vs none with traditional steroid. The medication is more expensive, somewhere in the $500-600 range, but is billed with a J code and reimbursed by Medicare as well as nearly every other insurance in Oklahoma. We make a $31 profit when using Zilretta over costs with what insurance pays, hardly what most would call padding the ancillary income. Dose the increased cost of the drug make it worth the extra weeks worth of pain relief, maybe. Nearly every Ortho group in town is using this regularly for what it’s worth.
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is it a pain to get it mixed up?
 
Not a pain to mix up at all. No different than drawing 10mg of dex and diluting with lidocaine.

I don’t have the studies, and I do believe they were company sponsored. Simply comparing the extended release version of the drug to the regular formulation seems to be a pretty straight forward process. They injected patients and measured blood levels of steroid, blood sugar increases, and intra-articular steroid levels and published the results. We decided if Medicare was covering the cost of the drug we’d go ahead and start using it.
 
okay I looked. limited studies - phase 2 and phase 3 clinical trials - that were done to get it approved.

as noted previously, may cause less elevations in blood sugars.

but then again clinical trials frequently don't show real life risks/benefits.
 
The Zilretta rep came by today (again). I have not tried it yet. Last post on this thread was Jun 2019, so just wondering if anyone has any new info or experience with Zilretta?
 
Some folks are doing good on it. No prior auth for most United or Anthem patients who that's who we are using it on (along w/ Medicare).
 
Mixing it up is easy, it comes with its own diluent and it's so proprietary they don't even tell you what the ingredients in it are. I've had one type 1 diabetic tell me it did not affect their blood sugar in any way. I've used it maybe 5 times and haven't had anyone come back asking for a second zilretta injection. I could use it more frequently but I don't want to eat the cost of this really expensive med if it turns out we didn't get authorization to use it.
 
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