03-04 IBD Tx & Risk/Benefit

Question 1

<p>OBJECTIVE: interpret data regarding the relative and absolute risks and benefits of IBD therapy</p>

Answer 1

<p>blah</p>

Question 2

<p>OBJECTIVE: List and describe the different classes of medications used to treat IBD. Discuss their mechanisms of action and associated risks, and appropriate use.</p>

Answer 2

<p><strong>5-ASA</strong></p>

<ul>
<li>e.g. sulfasalazine, mesalamine</li>
<li>used for mild-to-moderate dz</li>
<li>PO or PR</li>
<li>mesalamine works for UC but not really for Crohn&#39;s</li>
</ul>

<p><strong>Corticosteroids and antibiotics</strong></p>

<ul>
<li>put out fires</li>
</ul>

<p><strong>Immunomods</strong></p>

<ul>
<li>e.g. azathioprine (Imuran) &rarr; 6-MP, MTX</li>
<li>mod-to-severe dz</li>
</ul>

<p><strong>Anti-TNF&alpha; Biologics</strong></p>

<ul>
<li>e.g. infliximab, adalimumab, certolizumab</li>
<li><u>Anti-&alpha;4-integrin</u>:&nbsp;natalizumab
<ul>
<li><em>PML/JC virus risk</em></li>
</ul>
</li>
<li>mod-to-severe dz</li>
</ul>

<p>Best Tx of mod-to-severe dz results from Rx = immunomod + Anti-TNF&alpha;</p>

<p><em>[See drug lecture cards for MoA, ADRs, etc.]</em></p>

Question 3

<p>OBJECTIVE: Class: Immunomodulators</p>

<ul>
<li>Associated Risks</li>
<li>Appropriate Use</li>
</ul>

Answer 3

<p><strong>E.G.:</strong> 6-MP</p>

<p><strong>Associated Risks</strong>: allergic rxn (2%), nausea (2%), hepatitis (2%), pancreatitis (3%), serious infx, N-H lymphoma (0.04% vs. 0.02% in gen pop) &mdash;Overall ~10% of pts stop Rx due to ADR</p>

<p>&nbsp;</p>

<p><strong>Appropriate Use</strong>: synergistic effect when given w/ immunomod Rx (e.g. azathioprine)</p>

Question 4

<p>OBJECTIVE: Clas: Biologics MoA Associated Risks Appropriate Use</p>

Answer 4

<p><strong>MoA</strong>: Block effects of TNF&alpha;</p>

<p>&nbsp;</p>

<p><strong>Associated Risks:</strong> serious infx (3%), lymphoma (0.06% vs. 0.04% w/ immunomods and 0.02% in gen pop) &mdash;these &quot;do happen&quot;)</p>

<ul>
<li>less commonly/importantly: infusion site rxn (3-20%), drug-related SLE-like rxn (1%), TB (0.05%)</li>
<li>rare case reports: TB, MS, CHF, serious liver injury</li>
</ul>

<p><em>Natalizumab</em></p>

<ul>
<li>works in people who&#39;ve failed everything else</li>
<li>can rarely cause PML in pts infected w/ JC virus</li>
<li>test all these pts for JC virus</li>
</ul>

<p><strong>Appropriate Use</strong>: moderate-to-severe U.C or Crohns in combo w/ immunomodulator</p>

Question 5

<p>OBJECTIVE: Illustrate the most effective techniques to communicate to patients data regarding the risks and benefits of the various IBD therapies</p>

Answer 5

<ul>
<li>Use absolute > relative risk</li>
<li>avoid d.e.c.i.m.a.l.s.</li>
<li>visual aids</li>
<li>compare to risk of other things like taking prednisone which people are more familiar with but which has serious ADRs! that are common!</li>
</ul>

<p>Lifetime Chance of Dying from....</p>

<ul>
<li><span>lightning 1:80,000</span></li>
<li>bicycling accident: 1:5000</li>
<li>drowning 1:1000</li>
<li>car accident 1:300</li>
<li>cancer 1:8</li>
</ul>

Question 6

<p>OBJECTIVE: Propose an approach for communicating rare but life threatening adverse reactions to patients</p>

Answer 6

<p>Use ten thousand people infographic</p>

Question 7

<p>OBJECTIVE: Discuss the threshold of risk patients are willing to take in choosing a specific therapy based on their disease severity</p>

Answer 7

<p>Point in discussion was that people tend to be more willing to take on risk when their symptoms/disease/prognosis is worse.</p>

Question 8

<p>What is risk?</p>

Answer 8

<p>Risk = probability X consequence &mdash;People&#39;s knowledge of a risk and their feeling of control about it influence the way they think about risk</p>