Exabis Library

Educational objectives

How to define endoscopic remission (ER) and transmural remission (TR) in Crohn’s disease

PROS and CONS for endoscopic remission in CD

PROS and CONS for transmural remission in CD

An innovative technique to overcomne the actual technical limitations of pouch surgery

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