As noted in previous blog post, I wanted to share some notes from recent Atlanta CCFA talk.
The fourth lecture by Jeffry Katz discussed optimizing biologic therapy. Overall this was an excellent review. He discussed his general preference for combination therapy since the publication of the SONIC study. Also, he highlighted a smaller study that showed better efficacy with combination therapy in ulcerative colitis as well (DDW 2011, Abstract #835).
With regard to withdrawal of therapy when doing well on combination treatment, he indicated that he sometimes reduces (or stops) dosage of immunomodulator after 1 year but tries to avoid stopping anti-TNF agents. Relapse rates after stopping infliximab in Crohn’s disease are approximately 50% at 1 year and 75% at 5 years.
His talk reviewed antibodies to infliximab and low therapeutic levels. This has been discussed on this blog previously:
- Monitoring TNF antagonists in inflammatory bowel … – gutsandgrowth
- Drug levels for inflammatory bowel disease | gutsandgrowth
- Adding Methotrexate to anti-TNF therapy | gutsandgrowth
He reviewed risks of the IBD medications. With regard to psoriasis reactions, he stated that developing skin lesions occur in about 5% and this necessitates drug withdrawal in 1%. As these skin reactions are often a ‘class effect,’ use of an alternative may be needed. He stated that he had used ustekinumab in this setting (“but this entails a fight with the insurance company”).
The 5th talk by Doug Wolf reviewed pregnancy in IBD. Much of the information has also been discussed in this blog recently: Anti-TNFs and Pregnancy | gutsandgrowth
His key points:
- Probably stop infliximab at gestational week 32
- Likely give adalimumab up until week 34-36
- If patient in remission, consider stopping stopping drugs earlier
- In PIANO registry (n=1000), use of anti-TNFs and immunomodulators was not associated with any complication, including prematurity, spontaneous abortion, intrauterine growth retardation or specific birth defects. However, there was a significant increase in infant infections up to 12 months of life in the combination therapy group.
- No live virus vaccines (eg. rotavirus) for first 6 months for infants exposed to infliximab
The last talk that I attended was a pediatric case presentation from Cary Sauer. He presented a teenage boy who had mild disease based on bloodwork and endoscopy who had more severe and extensive disease on magnetic resonance enterography (MRE) (More imaging needed? | gutsandgrowth) and video capsule endoscopy. He argued that small bowel assessment is worthwhile in every patient at the time of diagnosis as more severe findings could influence the choice to start with top-down therapy.
The final aspect worth mentioning were some of the patient-related information:
1. A pediatric, adolescent, and parent support group will have its first meeting April 23rd 6-7:30 pm at Scottish Rite Children’s Hospital (Main auditorium). Followup meetings are scheduled for August 27, and October 22. All meetings are free. Contact CCFA firstname.lastname@example.org or 646-623-4869 (cell) for more information.
2. CCFA also has “Power of Two.” This contacts patients/parents with peer mentors. Interested patients can contact email@example.com or 404-982-0616.