Exabis Library

Appreciate the scope of issues relating to malignancy in IBD including malignancy related to disease and to medication
Consider the strategies used to mitigate risk of malignancy
Review screening protocols for malignancy in IBD

Subcutaneous (SC) formulations of CT-P13 and vedolizumab (VED) are currently available as new treatment option for patients with inflammatory bowel disease (IBD). The decision to switch requires a shared decision making based on adequate education of the patient, to avoid negative outcomes due to a nocebo effect. The aims of this study were (1) to evaluate the percentage of patients with IBD in favour of switching to SC formulations and (2) to compare two educational strategies.

This was a multicentre study in patients with IBD on maintenance intravenous (IV) CT-P13 or VED. Patients attending the infusion unit were invited to complete a survey exploring the willingness to switch to SC formulations. In centre A, all patients were informed on the new SC formulations and the accompanying care pathway by an information leaflet and a face-to-face interaction with the IBD nurse, prior to completing the survey. In centre B, patients on a minimal interval of q8w were digital invited to the same survey via the e-health application of the hospital. Demographics, patient reported outcomes, willingness to switch and reasons for IV vs. SC preferences were captured.

In total, 447 (n=183 Centre A; n=264 Centre B; participation ratio 83.6%) patients completed the survey (m/f: 212/235; CD/UC/IBD-U: 275/161/11; median age 45 IQR 33-57; remission CD/UC: 75%/82%) see table. Most patients were open to SC treatment (47% yes, 33% doubt, 20% no). The main driver to switch was an anticipated decrease in hospital visits (86%) and overall time gain (78%). The main reason to continue IV was fear of change (60%) and uncertainty in case of relapse after switch to a SC formulation (46%). In univariate analysis, the self-estimated compliance rate was associated with the willingness to switch (p<0.0001). To evaluate the impact of the approach in patient education between the two centres, we compared the subgroup of patients on ≥q8w interval with a dosing of 5-10mg/kg CT-P13 or 300 mg VED (n=335). The willingness to switch was higher after a face-to-face approach (centre A) compared to a merely digital approach (centre B;  53.9 % vs. 40.9 % p=0.038), although patients in centre B had a higher educational level (p=0.003), more prior experience with other IBD SC medication (p=<0.001), lived further from the hospital (p<0.001) and had a younger age at diagnosis (p=0.019).

In this multicentre comparative study exploring the willingness to switch from IV to SC maintenance therapy with CT-P13 and VED, the majority is open to switch to a SC formulation. The direct approach and education of the patient by the IBD nurse impacts significantly the willingness to switch. In a follow-up we will investigate the actual switch rates.

1. To review flare management and optimisation of biologic treatments using TDM  
2. To choose an appropriate therapy for pregnant IBD patients
3. To learn how to plan peri-partum care

Educational objectives:
1. To discuss the diagnosis and management of newly diagnosed ulcerative colitis
2. To determine when and how to switch from one treatment to another to optimize management of ulcerative colitis
3. To examine anti-TNF drug and antibody levels to optimize dosing
4. To discuss preconception counseling to achieve favourable maternal and neonatal outcomes and understand the conditions under which treatments should or should not be stopped during pregnancy and lactation

Summary

We present here a case of newly diagnosed ulcerative colitis and will discuss with experts the management strategies in case of persistent disease activity, including the interest of combination therapy and therapeutic drug monitoring to guide management decision.
Preconception counseling to achieve favourable maternal and neonatal outcomes, safety of treatment during pregnancy and lactation, and management of a flare during pregnancy will also be discussed.

1. To review the therapeutic goals and patient needs in UC
2. To confer different treatment strategies in UC
3. To discuss therapeutic options in UC
4. To emphasize the advantage of tight disease control

1. To review the therapeutic goals and patient needs in UC
2. To confer different treatment strategies in UC
3. To discuss therapeutic options in UC
4. To emphasize the advantage of tight disease control

This course is designed for gastroenterologists, surgeons, paediatricians, pathologists and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD). One major aim of this e-learning activity is to increase competence and knowledge with regard to the prediction, diagnosis and management of Ulcerative Colitis (UC) patients and to harmonise diagnostics and treatment in order to improve patient outcomes.

Upon completion of this activity learners will:

• Have insights into the basic epidemiology of ulcerative colitis
• Know current treatment options for severe ulcerative colitis, including colectomy
• Be able to use ciclosporin correctly in severe ulcerative colitis
• Understand when to order thiopurine methyltransferase (TPMT) activity when starting azathioprine

Ulcerative colitis is a lifelong disease arising from an interaction between genetic and environmental factors, observed predominantly in the developed countries of the world. The precise aetiology is unknown and therefore medical therapy to cure the disease is not yet available. Within Europe there is a North–South gradient, but the incidence appears to have increased in Southern and Eastern countries in recent years.1,2 Patients may live with a considerable symptom burden despite medical treatment (66% describe interference with work and 73% with leisure activities3) in the hope that the aetiology of ulcerative colitis will shortly be revealed and a cure emerge. Although this is conceivable in the next decade, clinicians have to advise patients on the basis of information available today. Despite randomised trials there will always be many questions that can only be answered by the exercise of judgement and opinion. This leads to differences in practice between clinicians, which may be brought into sharp relief by differences in emphasis between countries.

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice for most patients with ulcerative colitis (UC) requiring colectomy.1 Pouchitis is a non-specific inflammation of the ileal reservoir and the most common complication of IPAA in patients with UC.2–7 Its frequency is related to the duration of follow up, occurring in up to 50% of patients 10 years after IPAA in large series from major referral centres.1–9 The cumulative incidence of pouchitis in patients with an IPAA for familial adenomatous polyposis is much lower, ranging from 0 to 10%.10–12 Reasons for the higher frequency of pouchitis in UC remain unknown. Whether pouchitis more commonly develops within the first years after IPAA or whether the risk continues to increase with longer follow up remains undefined.

This course is designed for nurses with an interest in IBD. The intended results of this activity are increased competence, knowledge and performance and improved patient outcomes.

Upon completion of this activity learners will:

• Have thought through what key information a newly diagnosed patient with Ulcerative Colitis (UC) needs
• Know about the use of mesalazine medication in the treatment of mild to moderate colitis
• Understand issues of compliance for patients on maintenance treatment
• Understand issues of follow-up and support for patients with UC

This course is designed for gastroenterologists, paediatricians, surgeons and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD). The intended result of this activity is increased competence and knowledge of the role of imaging techniques, particularly ultrasonography, in the diagnosis and follow-up of IBD patients.

Upon completion of this activity learners will:

• Understand the role of ultrasonography (US) in the initial diagnostic work-up of suspected IBD
  
• Be able to provide a comprehensive overview of normal and abnormal findings in bowel US, with a focus on IBD
• Be able to understand the usefulness of bowel US in the follow-up of IBD, in assessing disease activity, response to therapy and monitoring disease progression and complications such as stenosis, fistulae and abscesses