Standardizing Use of JOURNAVX® (suzetrigine) at Desert Orthopedic Center

Adding a Nonopioid to Joint Replacement Order Sets

Driven by the desire to offer a nonopioid medication, as well as multimodal pain management goals and patient requests, Desert Orthopedic Center added JOURNAVX as an option to its order sets for joint replacement surgeries, following its initial use with a small number of patients. This case study highlights early real-world adoption of JOURNAVX as an oral nonopioid for moderate-to-severe acute pain, including postoperative pain, in adults undergoing joint replacement procedures.

This case study is based on interviews with Dr Erik Schnaser, a physician employed by Desert Orthopedic Center. Dr Schnaser was compensated by Vertex for participating in these interviews. This is a single organization’s experience and does not reflect the broader experience of all organizations.

Executive Summary

Organization Snapshot
Desert Orthopedic Center is an orthopedic and pain management private practice that is integrated into a large health system that operates out of 3 locations in the Palm Springs, California, area and serves a significant Medicare population. Desert Orthopedic Center performs 38,000 surgical procedures per year, including joint replacement, spine surgery, arthroscopic procedures, foot and ankle surgery, and hand and upper extremity surgery.

Goals
(1) Support a multimodal, opioid-free pain management approach, (2) reduce opioid-related adverse events, and (3) meet patient demand for nonopioid options.

Intervention
Beginning in May 2025, Desert Orthopedic Center piloted JOURNAVX for moderate-to-severe acute pain in a small subset of joint replacement patients. They gradually expanded it to be part of the standardized order sets for joint replacement surgeries for appropriate patients.

Qualitative Results Based on Interviews
Early experience with JOURNAVX suggests a favorable patient response to having a nonopioid option.

INDICATION

JOURNAVX is indicated for the treatment of moderate-to-severe acute pain, including postoperative pain, in adults.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

Use of JOURNAVX with strong CYP3A inhibitors is contraindicated.

Please see additional Important Safety Information throughout and full Prescribing Information for JOURNAVX.

The Approach

• Initially provided PDMA-compliant samples of JOURNAVX to a small subset of patients undergoing joint replacement
• Broadened use to all appropriate patients undergoing joint replacement surgeries after receiving positive patient and physician feedback
• Updated electronic health record (EHR) order sets through an in-house Epic informaticist to encourage consistent physician adoption
• Discussed JOURNAVX at monthly joint replacement meetings, reinforcing awareness among key prescribers, including physicians and physician assistants
• Successfully advocated for health system formulary inclusion via the Pharmacy and Therapeutics (P&T) process, enabling inpatient or post-anesthesia care unit (PACU) use and ensuring a consistent treatment regimen
• Prescribed JOURNAVX during preoperative appointments a week prior to surgery to ensure timely access, given ~80% of joint replacement patients go home the same day

IMPORTANT SAFETY INFORMATION (CONTINUED)

WARNINGS AND PRECAUTIONS

Increased Risk of Adverse Reactions With Concomitant Use With Strong and Moderate CYP3A Inhibitors: Strong and moderate CYP3A inhibitors increase exposure of suzetrigine and its active metabolite, which may cause adverse reactions. Reduce the JOURNAVX dosage with moderate CYP3A inhibitors.

Please see additional Important Safety Information throughout and full Prescribing Information for JOURNAVX.

Key Learnings

Formulary inclusion of JOURNAVX enables consistent, standardized patient care

• Health system formulary inclusion of JOURNAVX allows for a consistent treatment regimen across different settings, such as inpatient, PACU, and outpatient; it also allows the loading dose for JOURNAVX to be administered in the inpatient setting or PACU post-procedure
• Outpatient use allows for physician experience prior to P&T review and approval

EHR integration and ongoing communication drive consistent provider adoption

• Addition of JOURNAVX to EHR order sets for all appropriate patients undergoing joint replacement surgeries supports provider adoption and standardization of postoperative pain management
• Discussion of JOURNAVX at monthly joint replacement meetings reinforces awareness among Desert Orthopedic Center’s physicians and physician assistants who play a key role in prescribing JOURNAVX

Preoperative planning and patient education improve patient access

• Proactive communication with patients about insurance coverage, out-of-pocket costs, and available support offerings (eg, savings cards) helps remove access barriers for patients and reduce callbacks related to affordability
• Working directly with retail pharmacies ensures patient coverage/access ahead of surgery

IMPORTANT SAFETY INFORMATION (CONTINUED)

WARNINGS AND PRECAUTIONS (CONTINUED)

Risk of Drug Interactions With Certain CYP3A Substrates: Suzetrigine is an inducer of CYP3A. If JOURNAVX is used with sensitive CYP3A substrates or CYP3A substrates where minimal concentration changes may lead to loss of efficacy, refer to the CYP3A substrate’s label for dosing instructions. Dosage adjustment of the CYP3A substrates may be required when starting or stopping JOURNAVX.

Please see additional Important Safety Information throughout and full Prescribing Information for JOURNAVX.

Organization Results

Early experience with JOURNAVX suggests:

Next Steps

The orthopedic research team will formally evaluate pain scores for patients taking JOURNAVX to further understand the impact of JOURNAVX adoption.

INDICATION
JOURNAVX is indicated for the treatment of moderate-to-severe acute pain, including postoperative pain, in adults.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS
Use of JOURNAVX with strong CYP3A inhibitors is contraindicated.

WARNINGS AND PRECAUTIONS
Increased Risk of Adverse Reactions With Concomitant Use With Strong and Moderate CYP3A Inhibitors: Strong and moderate CYP3A inhibitors increase exposure of suzetrigine and its active metabolite, which may cause adverse reactions. Reduce the JOURNAVX dosage with moderate CYP3A inhibitors.

Risk of Drug Interactions With Certain CYP3A Substrates: Suzetrigine is an inducer of CYP3A. If JOURNAVX is used with sensitive CYP3A substrates or CYP3A substrates where minimal concentration changes may lead to loss of efficacy, refer to the CYP3A substrate’s label for dosing instructions. Dosage adjustment of the CYP3A substrates may be required when starting or stopping JOURNAVX.

Risk of Drug Interactions With Certain Hormonal Contraceptives: Patients taking hormonal contraceptives containing progestins other than levonorgestrel and norethindrone should use additional nonhormonal contraceptives or use alternative contraceptives during treatment with JOURNAVX and for 28 days after.

Risk of Adverse Reactions in Patients With Moderate and Severe Hepatic Impairment: Patients with moderate hepatic impairment have higher systemic exposures of suzetrigine and its active metabolite, which may increase the risk of adverse reactions. Avoid use in patients with severe hepatic impairment and reduce dosage with moderate impairment.

ADVERSE REACTIONS
The most common adverse reactions occurring in ≥1% of patients treated with JOURNAVX and higher than placebo were pruritus, muscle spasms, increased blood creatine phosphokinase, and rash.

Please see full Prescribing Information for JOURNAVX.