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Management of the refractory IBD patient: What to do when anti-TNFα agents don't work or stop working?


Joseph B. Kirsner Professor of Medicine
Section Chief, Gastroenterology, Hepatology and Nutrition
Co-Director, Digestive Diseases Center
The University of Chicago Medicine
Chicago, IL



Biologic therapy with anti-TNFα agents is commonly used in inflammatory bowel disease (IBD). Although these can be effective, a significant proportion of patients with IBD are primary non-responders to anti-TNFα therapy while more than one-half of responders experience loss of response or suffer side effects. This practice pointer highlights strategies to determine if a patient is not responding with anti-TNFα therapy and next steps to take in order to treat these patients effectively.

This activity has been designed to meet the educational needs of gastroenterologists and registered nurses involved in the care of patients with inflammatory bowel disease (IBD).

Release date: June 1, 2015

Learning objectives

After completing this activity, the participant should be better able to:

  • Describe the emerging understanding regarding pathogenesis of loss of response in patients on anti-TNF therapy
  • Assess the pro-active assessment of monitoring anti-TNF therapy of IBD
  • Summarize the current literature about anti-integrin therapy in patients with IBD
  • Provide appropriate care and counsel for patients and their families.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

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