Wk 11: IBD (Crohn's treatment - Biologics) Flashcards
What is TNF-a?
Tumour necrosis factor alpha:
- Pro-inflammatory mediator
- Over expressed in IBD
- Responsible for chronic inflammatory process in intestinal tissue
What is used as the last option when there have been multiple failed previous therapies?
Biologics
What are the biologics used in IBD?
- Infliximab - Remicade®
- Adalimumab - Humira®
- Vedolizumab - Entyvio®
- Ustekinumab - Stelara®
- Golimumab - Simponi®
When are infliximab and adalimumab recommended?
- Adults with severe active CD
- Disease not responded to conventional therapy
- Intolerant or contraindication to conventional therapy
What can be used alongside infliximab to increase rates of remission?
Azathioprine
How long are the treatment plans for infliximab and adalimumab?
- Until treatment failure
- Until 12 months after start of treatment
(shortest course)
What is used as first line and second line biologics?
- 1st: infliximab
- 2nd: adalimumab
Which patients are contraindicated in the use of infliximab and adalimumab?
- Crohn’s abscess (infection)
- Mod-severe HF
- Multiple sclerosis
- TB
- Lymphoma
- Recurrent infections
- Hep B (adalimumab)
- Active infection
What is the main complications of infliximab?
Infusion reaction:
- Itching, fever, chills, difficulty breathing
- Rec rate of infusion/stop medication
How is adalimumab given?
- SC injection at home
- Watch site reactions + infections
What are the side effects of infliximab and adalimumab?
- Headaches
- Sore throat
- Swallowing difficulties
- Aches + pains in muscles + joints
- Leg/face swelling
- Nausea, di + abdominal pain
What are the long term effects of infliximab + adalimumab?
- Inc risk of lymphoma
- COPD/heavy smokers inc risk of cancer
- Exacerbate multiple sclerosis
What are the monitoring requirements of infliximab + adalimumab?
Monitor s/e after stopping therapy bc takes up to 6 months to completely remove from body
When should a patient report to a doctor when on infliximab + adalimumab
- Skin rashes
- Hives
- Frequent infections
What is golimumab -simponi?
- Anti-TNF agent
- Not for CD
- For mod UC where treatment has failed/intolerated
- Sc injection into thigh/stomach
What is vedolizumab - entyvio?
- IgG1 monoclonal antibody
- For mod/severe CD + UC if anti-TNF not suitable/CI
- IV
What is the mechanism of action of vedolizumab - entyvio?
- Gut selective integrin blocker
- Over prod of WBC = inflammation
- Vedolizumab stops WBC entering gut lining
What is Ustekinumab - stelara?
- Mod/severe active CD
- Anti-TNF therapy not tolerated/CI
- IV then SC
What is the mechanism of action of Ustekinumab - stelara?
- Targets IL-12 + 23
- Inc in IBD = gut inflammation
- Bind to IL 12 + 23 to red inflammation
What is used to monitor TNF-alpha inhibitors in CD?
- LISA-TRACKER
- IDKmonitor
- Promonitor ELISA
When are biosimilars used?
If patient is in remission or stable response to OG prod
What is the maintenance therapy of CD?
- Azathioprine/mercaptopurine
- Methotrexate
- Infliximab or adalimumab
