Lecture 10 IBD Part 4 Flashcards
Sphingosine 1-Phosphate (SP1) (lymphocyte)Receptor agonist for IBD tx (MOA, drugs/dose, indication, AE, Contra)
MOA: does this = reduces lymphocyte release/migration into intestine,, Drugs/Dose: Ozanimod (Zeposia) - dose escalated to 0.92 mg PO QD (discontinue if no benefit at 10 weeks)
Indication: moderate-severe UC with loss of response or inadequate or intolerant to conventional tx or biologics
AE: URTI: more common in first year, comorbidities like DM, COPD, and steroid use increase risk
H/A
nausea, upset stomach, diarrhea
back pain, muscle ache, herpes zoster/other infections, decreased HR, macular edema, increased ALT/AST/bilirubin
Contra: recent CV event, AV block, active infection, use of MAOI
How should biologic IBD tx be managed if patient has an infection?
hold until 2 days after antibiotics complete and/or sx resolved, including topical infections, don’t need to hold for minor colds
they should also be held pre-op and post-op to decrease risk of infection
How should biologics and other IBD txs be managed in pregnancy?
TNFi: 1st and 2nd trimester considered safe
3rd trimester has concerns of affecting immunity of baby
other biologics have lack of evidence
Aminosalicylates: can be used, ensure folic acid with sulfasalazine as can affect them
Prednisone: can be used, use cautiously in 1st trimester - very low risk of cleft palates
Thiopurines: can be used, AVOID methotrexate (discontinue at least 3 months before)
JAKi: AVOID, discontinue at least 4-6 weeks before
SP-1 Agonist: AVOID, discontinue at least 3 months before
How is drug coverage for UC tx (ABC/NIHB)?
moderate-severe UC (NIHB partial Mayo >4): mesalamine/(NIHB 5-ASA) 4g/day (4 week trial, NIHB 6), prednisone 40 mg QD (2 week trial) or steroid dependent, if warranted AZA/6-MP (2 months)
for continued coverage pt must have good response, maintain the response, and cannot switch back to a previously trialed tx
only one covered at a time
How is drug coverage for CD tx (ABC/NIHB)?
moderate-active CD: mesalamine 3g/day (6 week trial), prednisone 40 mg QD (8 week taper/NIHB x 2 weeks) or steroid dependent, AZA 2mg/kg/day or 6-MP 1mg/kg/day or MTX 15mg/week (all 3 months)
for continued coverage pt must have good response, maintain it, and cannot switch to a previously trialed tx
only one covered at a time
Cyclosporine for IBD tx (Dose, indication)
Dose: IV (2 mg/kg/day infused over 24 hours)
Indication: induction tx for acute-severe UC refractory to corticosteroids (not used as much for CD), rapid response within 1-2 weeks
What antibiotics may be used for IBD?
metronidazole or ciprofloxacin for CD
short 2-4 week courses (may be repeated)
CD with perianal or colonic involvement or with fistulas
What are core vaccine recommendations for IBD patients?
influenza, pneumococcus (Prevnar-20), tetanus (every 10 years), Zoster (age >50 +/- hx of shingles >/= 1 year prior), COVID-19
for at risk groups: HepA/B, HPV
