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

David T. Rubin MD, FACG, AGAF, FACP, FASGE

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

Biography

Statement of need

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.

Target audience

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
Expiry date: June 1, 2016

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.

Syllabus disclosure statement

Disclosure of conflicts of interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter

Reported Financial Relationship

David T. Rubin MD, FACG, AGAF, FACP, FASGE

Consultant: Abbvie, Emmi, Genentech, Ironwood, Janssen, Prometheus Pharmaceuticals, Santarus/Salix, Takeda, Telsar Pharmaceuticals, Vertex Pharmaceuticals, UCB Pharma

Grant Support: Abbvie, Elan Pharmaceuticals, Prometheus Pharmaceuticals, Shire, Warner Chilcott

Other: Cornerstones Health, Inc. (Co-Founder, non-profit medical education entity)


The planners and managers reported the following financial relationships or relationships they or their spouse/life partner have with commercial interests related to the content of this continuing education activity:

The following PIM planners and managers, Laura Excell, ND, NP, MS, MA, LPC, NCC, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CCMEP, Judi Smelker-Mitchek, RN, BSN, and Jan Schultz, RN, MSN, CCMEP, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The following SCI planners and managers, Ian Morgan, MSc, and Elena Urso, BSc, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity or any amount during the past 12 months.

Accreditation

Physician continuing education

Accreditation statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and Strategic Consultants International. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit designation

The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing continuing education

Credit designation

This educational activity for 0.7 contact hours is provided by Postgraduate Institute for Medicine.

Accreditation statement

Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Estimated time to complete activity: 45 minutes

Disclosure of unlabeled use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

How to obtain credit

There are no fees for participating and receiving CME/CE credit for this activity. To successfully earn credit, participants must complete the activity online during the valid credit period. Follow these steps to earn CME/CE credit:

  1. Read the target audience, learning objectives, and author disclosures
  2. Study the online educational content (can also be printed)
  3. Once the activity is complete, complete the online posttest, and the online evaluation.

Upon successful completion of the posttest, with a passing score of 75% or better, and the online Evaluation form, you will have immediate access to a CME/CE certificate to print or save for your files. We strongly encourage you to complete the Activity Evaluation to provide your feedback for future programming.

If you have any questions regarding the CME/CE certification for this activity, please contact Postgraduate Institute for Medicine at: information@pimed.com or (303) 799-1930.

Media: Internet

Disclaimer

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.

This activity is jointly provided by Postgraduate Institute for Medicine
and Strategic Consultants International
PIM Logo  
This activity is supported by an independent educational grant from American Regent,
Takeda Pharmaceuticals International, Inc., US Region, UCB, Inc.