Wk 11: IBD (Crohn's treatment - Biologics)

Question 1

What is TNF-a?

Answer 1

Tumour necrosis factor alpha:

• Pro-inflammatory mediator
• Over expressed in IBD
• Responsible for chronic inflammatory process in intestinal tissue

Question 2

What is used as the last option when there have been multiple failed previous therapies?

Answer 2

Biologics

Question 3

What are the biologics used in IBD?

Answer 3

• Infliximab - Remicade®
• Adalimumab - Humira®
• Vedolizumab - Entyvio®
• Ustekinumab - Stelara®
• Golimumab - Simponi®

Question 4

When are infliximab and adalimumab recommended?

Answer 4

• Adults with severe active CD
• Disease not responded to conventional therapy
• Intolerant or contraindication to conventional therapy

Question 5

What can be used alongside infliximab to increase rates of remission?

Answer 5

Azathioprine

Question 6

How long are the treatment plans for infliximab and adalimumab?

Answer 6

• Until treatment failure
• Until 12 months after start of treatment

(shortest course)

Question 7

What is used as first line and second line biologics?

Answer 7

• 1st: infliximab
• 2nd: adalimumab

Question 8

Which patients are contraindicated in the use of infliximab and adalimumab?

Answer 8

• Crohn’s abscess (infection)
• Mod-severe HF
• Multiple sclerosis
• TB
• Lymphoma
• Recurrent infections
• Hep B (adalimumab)
• Active infection

Question 9

What is the main complications of infliximab?

Answer 9

Infusion reaction:

• Itching, fever, chills, difficulty breathing
• Rec rate of infusion/stop medication

Question 10

How is adalimumab given?

Answer 10

• SC injection at home
• Watch site reactions + infections

Question 11

What are the side effects of infliximab and adalimumab?

Answer 11

• Headaches
• Sore throat
• Swallowing difficulties
• Aches + pains in muscles + joints
• Leg/face swelling
• Nausea, di + abdominal pain

Question 12

What are the long term effects of infliximab + adalimumab?

Answer 12

• Inc risk of lymphoma
• COPD/heavy smokers inc risk of cancer
• Exacerbate multiple sclerosis

Question 13

What are the monitoring requirements of infliximab + adalimumab?

Answer 13

Monitor s/e after stopping therapy bc takes up to 6 months to completely remove from body

Question 14

When should a patient report to a doctor when on infliximab + adalimumab

Answer 14

• Skin rashes
• Hives
• Frequent infections

Question 15

What is golimumab -simponi?

Answer 15

• Anti-TNF agent
• Not for CD
• For mod UC where treatment has failed/intolerated
• Sc injection into thigh/stomach

Question 16

What is vedolizumab - entyvio?

Answer 16

• IgG1 monoclonal antibody
• For mod/severe CD + UC if anti-TNF not suitable/CI
• IV

Question 17

What is the mechanism of action of vedolizumab - entyvio?

Answer 17

• Gut selective integrin blocker
• Over prod of WBC = inflammation
• Vedolizumab stops WBC entering gut lining

Question 18

What is Ustekinumab - stelara?

Answer 18

• Mod/severe active CD
• Anti-TNF therapy not tolerated/CI
• IV then SC

Question 19

What is the mechanism of action of Ustekinumab - stelara?

Answer 19

• Targets IL-12 + 23
• Inc in IBD = gut inflammation
• Bind to IL 12 + 23 to red inflammation

Question 20

What is used to monitor TNF-alpha inhibitors in CD?

Answer 20

• LISA-TRACKER
• IDKmonitor
• Promonitor ELISA

Question 21

When are biosimilars used?

Answer 21

If patient is in remission or stable response to OG prod

Question 22

What is the maintenance therapy of CD?

Answer 22

• Azathioprine/mercaptopurine
• Methotrexate
• Infliximab or adalimumab