Case 1 History. William Tremaine, M.D. CP
|
|
- Antony Weaver
- 5 years ago
- Views:
Transcription
1 Extraintestinal Manifestations of IBD Case Studies William Tremaine, M.D. Case 1 History 18 year-old woman with Crohn s disease Onset at age 5: colonic & perianal Sulfasalazine, prednisone, mercaptopurine Long strictures: rectum and transverse colon Age 16 Proctocolectomy with ileostomy Age 17 Peristomal pyoderma gangrenosum CP
2 Case 1 History (continued) Age 18 Worsening pyoderma despite: Mercaptopurine, Infliximab Hughes AP. JAMA 2000;284:
3 Peristomal Pyoderma Gangrenosum Peristomal Pyoderma Gangrenosum Treatment options? 3
4 Conditions Associated with PG Crohn s disease Ulcerative colitis Chronic hepatitis Rheumatoid arthritis AML and CML Polycythemia vera Myeloma 30% to 50% may be idiopathic Demographics of PPG UC Crohn's Diverticulitis Adenoca Neurogenic Bladder Perforated bowel Lyon et al. J Am Acad Dermatol 2000:42:992 4
5 Demographics of PPG Annual incidence estimated at 0.6 per 100 ostomies 1 Time to onset after surgery 2 months to 25 years 2 1 Lyon et al. J Am Acad Dermatol 2000:42:992 Diagnosis of PPG Inflammatory disease in most Painful pink/purple papule Painful ulceration Raised purple edge Strands of persisting epidermis stretch across the ulcer Involves the area covered by the stoma bag adhesive plate 2 Hughes AP et al. JAMA 2000:284:1546 Lyon et al. J Am Acad Dermatol 2000:42:992 5
6 Diagnosis of PG: Rule out other causes of persistent ulcers Vascular occlusive or venous disease Antiphospholipid antibody syndrome Vasculitis Wegner s granulomatosis, Polyarteritis nodosum Lymphoma Deep fungal infection Exogenous tissue injury Munchausen s syndrome Cutaneous Crohn s disease Weenig et al. N Eng J Med 2002:347:1412 Common Misdiagnoses in PPG Stitch abscess Contact dermatitis Irritation from leakage of feces or urine Extension of underlying Crohn s disease Wound infection Hughes AP et al. JAMA 2000:284:1546 6
7 Diagnostic Tests Rule out other conditions Laboratory investigations None are pathognomonic Protein electrophoresis, CBC, coagulation panel, antiphospholipid antibody panel, cryoglobulins, vasculitis screen Biopsy No pathognomonic characteristics 46 of 86 (53%) of misdiagnosed patients in Mayo series had correct diagnosis evident on biopsy Therapy of PPG Current knowledge of therapy based on case series No RCTs Observational studies uniformly lack a control group Weenig et al. N Eng J Med 2002:347:1412 7
8 Systemic Agents Reported Possibly Effective in PG Corticosteroids Minocycline Dapsone Cyclosporine Tacrolimus Clofazamine Cyclophosphamide Melphalan Chlorambucil Powel et al. Dermatol Clin 2002:20:347 Azathioprine Methotrexate Interferon-α Potassium iodide Thalidomide Infliximab Adalimumab Mycophenolate mofetil Colchicine Medications for Severe PG Tacrolimus Cyclosporine Infliximab Cyclophosphamide Poritz LS. J Am Coll Surg 2008; 206: Alkhouri N. Inflam Bowel Dis (6):
9 Topical Tacrolimus for PPG Topical tacrolimus - 7 of 11 healed in mean 5.1 weeks vs. Topical steroids - 5 of 13 healed in mean 6.5 weeks Topical tacrolimus superior for large lesions (> 2cm in diameter) Lyon CC et al. J Dermatol Treatment 2001;12:13 IV Cyclosporine Mt Sinai 11 patients with steroid-refractory PG All healed with IV CSA followed by oral CSA Mean time to response 4.5 days Mean time to healed 1.4 months 9 of 11 discontinued steroids and were maintained on AZA/6-MP Friedman S et al. Inflammatory Bowel Disease 2001;7:1 9
10 Anti-TNFα Therapy for PG Relatively few reports Eight patients with PG and active CD 3 patients with complete healing and maintenance of healing 3 patients with partial healing or complete healing but relapse and intolerance to infliximab 2 patients without healing Response may depend on healing underlying CD but insufficient data to know for certain Ljung T et al. Scand J Gastroenterol 2002:37:1108 Cyclophosphamide for PG First reported in 1967 Pulse Cyclophosphamide first reported in 1994 Rapid healing and prolonged improvement in 2 patients with RA Additional data needed given recent evidence of effectiveness in CD Crawford SE et al. J pediatrics 1967:71:255 Zonana-Nacach A et al. J Rheumatol 1994:21:
11 Peristomal Pyoderma Summary Rule out other diagnoses Initial therapy with topical corticosteroids for small lesions and high dose corticosteroids or topical tacrolimus for large lesions Second line therapies include CSA, TAC, topical TAC, infliximab, other immunomodifiers, dapsone Comparative trials of therapies greatly needed Dermatological Manifestations Pyoderma gangrenosum 1-10% Erythema nodosum 1-10% Cutaneous Crohn s disease (rare) Psoriasis (up to 10%) Uncommon disorders Sweet s syndrome Epidermolysis bullosa acquisita 11
12 Erythema Nodosum More common in Crohn s (up to 15%), less in UC (up to 5%) Young women at most risk Painful tender erythematous nodules: pretibial, or areas of trauma Correlates with IBD activity Treat underlying IBD SKIN LESIONS Erythema Nodosum 12
13 Cutaneous Crohn s Disease Granulomatous lesions of skin Most common in perianal areas (e.g. tags) Metastatic Crohn s May not correlate with disease activity Steroids, immunosuppressives Case 2 Corneal Erosions 24 year old man Crohn s disease since age 18 Ileocolonic and perianal involvement Adalimumab weekly Nocturnal corneal erosions, recurrent Awakens with eye pain, dryness Rx: punctal plugs. Fell out. 13
14 Case 2 Corneal Erosions Case 2 Corneal Erosions (continued) Rx: punctal cautery, bilateral Still nocturnal awakening with burning eyes vaporizer, ointment, tetracaine Repeat trips to the ER for eye pain Stromal puncture, left eye 23-gauge needle, 200 corneal nicks Polytrim solution and erythromycin ointment: improved Right eye treatment: improved 14
15 Ocular Complications: Uveitis Inflammation of anterior chamber Prevalence 5% Ocular pain, redness, photophobia Slit lamp exam necessary for diagnosis Acute form associated with HLA B27 Chronic form not associated Treatment: Topical steroids, cycloplegic agents Oral steroids for refractory cases Immunosuppressives and anti-tnf agents Anterior Uveitis 15
16 Other Ocular Complications Episcleritis Episcleritis Outer layers of eye Eye burning or itching, erythema Activity correlates to IBD activity Topical corticosteroids Scleritis: more serious, oral steroids Retinitis: less common Cataracts, glaucoma due to steroids 16
Management of Pyoderma Gangrenosum Mentoring in IBD XVII
Management of Pyoderma Gangrenosum Mentoring in IBD XVII Scott Walsh MD PhD FRCPC Division of Dermatology Sunnybrook Health Sciences Centre University of Toronto Pyoderma Gangrenosum: A pathological
More informationExtraintestinalManifestations of IBD
ExtraintestinalManifestations of IBD Hyun Kim, M.D. San Diego Digestive Disease Consultants Associate Professor, UCSD School of Medicine Why Other Organs Involved in IBD? Organ Involvement Bones, Joints
More informationMore Non-infectious Granulomatous Diseases! Karolyn Wanat, MD Assistant Professor, Dermatology & Pathology University of Iowa
More Non-infectious Granulomatous Diseases! Karolyn Wanat, MD Assistant Professor, Dermatology & Pathology University of Iowa Conflicts of Interest/Disclosure None Classification/Overview 1) Necrobiotic/Palisading
More informationBeyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease
Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease Robert Isfort, M.D. TriHealth Digestive Institute IBD Family Education Day 2019 Learning Objectives Review manifestations
More informationSURGICAL MANAGEMENT OF ULCERATIVE COLITIS
SURGICAL MANAGEMENT OF ULCERATIVE COLITIS Cary B. Aarons, MD Associate Professor of Surgery Division of Colon & Rectal Surgery University of Pennsylvania AGENDA Background Diagnosis/Work-up Medical Management
More informationTreatment of Inflammatory Bowel Disease. Michael Weiss MD, FACG
Treatment of Inflammatory Bowel Disease Michael Weiss MD, FACG What is IBD? IBD is an immune-mediated chronic intestinal disorder, characterized by chronic or relapsing inflammation within the GI tract.
More informationCrohn s Disease. Resident Lecture 1/17/19
Crohn s Disease Resident Lecture 1/17/19 Objectives Features/Classification of Crohn s Disease Medical Treatment Surgical Indications Surgical Considerations 2 Case 25 yo F presents to your office with
More informationTopical Tacrolimus for Parastomal Pyoderma Gangrenosum: A Report of Two Cases
Topical Tacrolimus for Parastomal Pyoderma Gangrenosum: A Report of Two Cases Maria Altieri, MS; Khashayar Vaziri, MD; and Bruce A. Orkin, MD Abstract Pyoderma gangrenosum (PG) is an idiopathic, ulcerative,
More informationINFLAMMATORY BOWEL DISEASE. Jean-Paul Achkar, MD Center for Inflammatory Bowel Disease Cleveland Clinic
INFLAMMATORY BOWEL DISEASE Jean-Paul Achkar, MD Center for Inflammatory Bowel Disease Cleveland Clinic WHAT IS INFLAMMATORY BOWEL DISEASE (IBD)? Chronic inflammation of the intestinal tract Two related
More informationCrohn's disease CAUSES COURSE OF CROHN'S DISEASE TREATMENT. Sulfasalazine
Crohn's disease Crohn's disease is an inflammatory condition of the digestive tract that affects children and adults. Common features of Crohn's disease include mouth sores, diarrhea, abdominal pain, weight
More informationIBD in teenagers Biological and Transition
IBD in teenagers Biological and Transition Dr Warren Hyer Consultant Paediatric Gastroenterologist St Mark s Hospital Chelsea and Westminster Hospital Conflict of Interest None to declare Fee for presentation
More informationPEDIATRIC INFLAMMATORY BOWEL DISEASE
PEDIATRIC INFLAMMATORY BOWEL DISEASE Alexis Rodriguez, MD Pediatric Gastroenterology Advocate Children s Hospital Disclosers Abbott Nutrition - Speaker Inflammatory Bowel Disease Chronic inflammatory disease
More informationPharmacy Prior Authorization
Pharmacy Prior Authorization AETA BETTER HEALTH PESLVAIA & AETA BETTER HEALTH KIDS Humira (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information,
More informationIndex. Surg Clin N Am 87 (2007) Note: Page numbers of article titles are in boldface type.
Surg Clin N Am 87 (2007) 787 796 Index Note: Page numbers of article titles are in boldface type. A Abscesses in anorectal Crohn s disease, 622 intra-abdominal, in Crohn s disease, 590 591 perirectal,
More informationINFLIXIMAB Remicade (infliximab), Inflectra (infliximab-dyyb), Ixifi* (infliximabqbtx), Renflexis (infliximab-abda)
Pre - PA Allowance None Prior-Approval Requirements Diagnoses Patient must have ONE of the following: 6 years of age or older 1. Moderate to severe Crohn s disease (CD) a. Patient has fistulizing disease
More informationThe Spectrum of IBD. Inflammatory Bowel Disease. Symptoms. Epidemiology. Tests for IBD. CD or UC? Inflamatory Bowel Disease. Fernando Vega, M.D.
The Spectrum of IBD Inflammatory Bowel Disease Fernando Vega, M.D. Epidemiology CD and UC together 1:400 UC Prevalence 1:500 UC Incidence 6-12K/annum CD Prevalence 1:1000 CD Incidence 3-6K/annum Symptoms
More informationIBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition
IBD 101 Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Objectives Identify factors involved in the development of inflammatory bowel
More informationThe ABCs of Inflammatory Bowel Disease. Jennifer Choi, M.D. Associate Director March 31, 2012
The ABCs of Inflammatory Bowel Disease Jennifer Choi, M.D. Associate Director March 31, 2012 What Will This Talk Cover? What is IBD? What causes it? What are complications of it? How do I find out if I
More informationEfficacy and Safety of Treatment for Pediatric IBD
Efficacy and Safety of Treatment for Pediatric IBD Andrew B. Grossman MD Co-Director, Center for Pediatric Inflammatory Bowel Disease Associate Professor of Clinical Pediatrics Division of Gastroenterology,
More informationSurgical Management of IBD. Val Jefford Grand Rounds October 14, 2003
Surgical Management of IBD Val Jefford Grand Rounds October 14, 2003 Introduction Important Features Clinical Presentation Evaluation Medical Treatment Surgical Treatment Cases Overview Introduction Two
More informationLaurie S. Conklin, M.D. Inflammatory Bowel Disease Program Children s National Medical Center
Laurie S. Conklin, M.D. Inflammatory Bowel Disease Program Children s National Medical Center CROHN S DISEASE Patchy inflammation Mouth to anus involvement Full-thickness inflammation Variable involvement
More informationPyoderma gangrenosum presenting with acute generalised haemorrhagic bullae
H.K. Dermatol. Venereol. Bull. (2003) 11, 155-159 Case Report Pyoderma gangrenosum presenting with acute generalised haemorrhagic bullae YH Chan, WYM Tang, WY Lam A 31-year-old Chinese man presented with
More informationDefinitions. Clinical remission: Resolution of symptoms (stool frequency 3/day, no bleeding and no urgency)
CROHN S DISEASE Definitions Clinical remission: Resolution of symptoms (stool frequency 3/day, no bleeding and no urgency) Recurrence: The reappearance of lesions after surgical resection Endoscopic remission:
More informationCASE REPORT ATYPICAL BULLOUS PYODERMA GANGRENOSUM WITH EARLY LESIONS MIMICKING CHICKEN POX
ATYPICAL BULLOUS PYODERMA GANGRENOSUM WITH EARLY LESIONS MIMICKING CHICKEN POX Ramesh M 1, Kavya Raju Nayak 2, M.G. Gopal 3, Sharath Kumar B.C 4, Nandini A.S 5 HOW TO CITE THIS ARTICLE: Ramesh M, Kavya
More informationC. Assess clinical response after the first three months of treatment.
Government Health Plan (GHP) of Puerto Rico Authorization Criteria Tumor Necrosis Factor Alpha (TNFα) Adalimumab (Humira ) Managed by MCO Section I. Prior Authorization Criteria A. Physician must submit
More informationBeyond Anti TNFs: positioning of other biologics for Crohn s disease. Christina Ha, MD Cedars Sinai Inflammatory Bowel Disease Center
Beyond Anti TNFs: positioning of other biologics for Crohn s disease Christina Ha, MD Cedars Sinai Inflammatory Bowel Disease Center Objectives: To define high and low risk patient and disease features
More informationPharmacy Prior Authorization
Pharmacy Prior Authorization MERC CARE PLA (MEDICAID) Humira (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax
More informationEpidemiology / Morbidity
Perianal Crohn s Disease: Current Treatment Approach David A Schwartz, MD Director, Inflammatory Bowel Disease Center Vanderbilt University Medical Center Epidemiology / Morbidity Hellers et al, Gut 1980
More informationULCERATIVE COLITIS. Sean Lynch, MD and Richard Bloomfeld, MD Wake Forest University School of Medicine Winston-Salem, NC
ULCERATIVE COLITIS Sean Lynch, MD and Richard Bloomfeld, MD Wake Forest University School of Medicine Winston-Salem, NC What is Ulcerative Colitis? Ulcerative colitis (UC) is a disease marked by inflammation
More informationSlide 1 Medications in inflammatory bowel disease a primer for health care providers. Slide 2. Slide 3 Theory of pathogenesis. IBD - epidemiology
Slide 1 Medications in inflammatory bowel disease a primer for health care providers Athos Bousvaros, MD Associate director Inflammatory Bowel Disease Center Boston Children s Hospital 617 355 2962 Slide
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Centre for Clinical Practice SCOPE Clinical guideline title: Ulcerative colitis: the management of ulcerative colitis Quality standard title: Ulcerative
More informationPIBD03 - Page 1 of June-03
ENROLLMENT INFO Patient Demographics [enroll01] Date of assessment [e_assessdt] 1. Patient birthdate: [birthdt] 2a. Month of diagnosis (please enter the 2-digit month) [e_diagmnth] 2b. Year of diagnosis
More informationAnne Griffiths MD, FRCPC. SickKids Hospital, University of Toronto. Buenos Aires, August 16, 2014
Management and Medical Therapies for Crohn disease: strategies to enhance mucosal healing Anne Griffiths MD, FRCPC SickKids Hospital, University of Toronto Buenos Aires, August 16, 2014 New onset Crohn
More informationScleritis LEN V KOH OD
Scleritis LEN V KOH OD 2014 PUCO 1 Introduction A painful, destructive, and potentially blinding disorder Highly symptomatic High association with systemic disease Immunosuppresssive agents 2014 PUCO 2
More informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 3 October 2012
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 3 October 2012 REMICADE 100 mg, powder for concentrate for solution for infusion B/1 vial (CIP code: 562 070-1) Applicant:
More informationRecognizing Pyoderma Gangrenosum in a Patient with History of Essential Thrombocytosis
Open Journal of Clinical & Medical Case Reports Volume 2 (2016) Issue 17 ISSN 2379-1039 Recognizing Pyoderma Gangrenosum in a Patient with History of Essential Thrombocytosis * Amier Ahmad, Md ; Kevin
More informationInfliximab: A Treatment Option for Ulcerative Pyoderma Gangrenosum
To Print: Click your browser's PRINT button. NOTE: To view the article with Web enhancements, go to: http://www.medscape.com/viewarticle/449955 Infliximab: A Treatment Option for Ulcerative Pyoderma Gangrenosum
More informationEfficacy and Safety of Treatment for Pediatric IBD
Efficacy and Safety of Treatment for Pediatric IBD Andrew B. Grossman MD Co-Director, Center for Pediatric Inflammatory Bowel Disease Assistant Professor of Clinical Pediatrics Division of Gastroenterology,
More informationWhat Will This Talk Cover? 101: The Basics of Inflammatory Bowel Disease. Terms & Abbreviations. What Is Normal GI Anatomy?
101: The Basics of Inflammatory Bowel Disease What Will This Talk Cover? What is IBD? What causes it? What are complications of it? How do I find out if I have IBD? How do we treat IBD? Jennifer Choi,
More information1 P a g e. Systemic Juvenile Idiopathic Arthritis (SJIA) (1.3) Patients 2 years of age and older with active systemic juvenile idiopathic arthritis.
LENGTH OF AUTHORIZATION: Initial: 3 months for Crohn s or Ulcerative Colitis; 1 year for all other indications. Renewal: 1 year dependent upon medical records supporting response to therapy and review
More informationIleal Pouch Anal Anastomosis: The Preferred Method of Reconstruction after Proctocolectomy in Children
Ileal Pouch Anal Anastomosis: The Preferred Method of Reconstruction after Proctocolectomy in Children Stephanie Jones, D.O. Surgical Fellow March 21, 2011 Ulcerative Colitis Spectrum of inflammatory bowel
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 1041-8 Program Prior Authorization/Notification Medication Humira (adalimumab) P&T Approval Date 1/2007, 6/2008, 4/2009, 6/2009,
More informationIBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition
IBD 101 Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Objectives Identify factors involved in the development of inflammatory bowel
More informationModerately to severely active ulcerative colitis
Adalimumab in the Treatment of Moderate-to-Severe Ulcerative Colitis: ULTRA 2 Trial Results Sandborn WJ, van Assche G, Reinisch W, et al. Adalimumab induces and maintains clinical remission in patients
More informationMy Child Has Inflammatory Bowel Disease : Why? What now? What s next?
My Child Has Inflammatory Bowel Disease : Why? What now? What s next? George M. Zacur, M.D., M.S. Clinical Assistant Professor Department of Pediatrics and Communicable Diseases Division of Gastroenterology
More informationAmjevita (adalimumab-atto)
*- Florida Healthy Kids Amjevita (adalimumab-atto) Override(s) Prior Authorization Quantity Limit Medications Amjevita 20 mg/0.4 ml prefilled syringe Amjevita (adalimumab-atto) 40 mg/0.8 ml 2 #* ^ prefilled
More informationMedical therapies and IBD
Medical therapies and IBD Although there is no cure for IBD, there are many treatment options available. There is no standard treatment for IBD that is effective in all situations or for all patients,
More informationTHE TIP OF THE ICEBERG SAMER BOLIS, DO PGY-3 LEHIGH VALLEY HEALTH NETWORK, ALLENTOWN PA
THE TIP OF THE ICEBERG SAMER BOLIS, DO PGY-3 LEHIGH VALLEY HEALTH NETWORK, ALLENTOWN PA Case The patient is a 48 year-old female, who recently returned from a trip to Puerto Rico. She presents to the ED
More informationFirst Name. Specialty: Fax. First Name DOB: Duration:
Prescriber Information Last ame: First ame DEA/PI: Specialty: Phone - - Fax - - Member Information Last ame: First ame Member ID umber DOB: - - Medication Information: Drug ame and Strength: Diagnosis:
More informationRHEUMATOLOGY OVERVIEW. Carmelita J. Colbert, MD Assistant Professor of Medicine Division of Rheumatology Loyola University Medical Center
RHEUMATOLOGY OVERVIEW Carmelita J. Colbert, MD Assistant Professor of Medicine Division of Rheumatology Loyola University Medical Center What is Rheumatology? Medical science devoted to the rheumatic diseases
More informationHow do I choose amongst medicines for inflammatory bowel disease. Maria T. Abreu, MD
How do I choose amongst medicines for inflammatory bowel disease Maria T. Abreu, MD Overview of IBD Pathogenesis Bacterial Products Moderately Acutely Inflamed Chronic Inflammation = IBD Normal Gut Mildly
More informationSelby Inflamm Bowel Dis. 2008:14:
Medical Management of Inflammatory Bowel Disease Freddy Caldera D.O. Assistant Professor Division of Gastroenterology Objectives Discuss Crohn s disease and Ulcerative Colitis Discuss Medications for Inflammatory
More informationRegional vs. Systemic Therapy. Corticosteroids. Regional vs. Systemic Therapy for Uveitis. Considerations
Regional vs. Systemic Therapy for Uveitis Nisha Acharya,, M.D., M.S. Director, Uveitis Service F.I. Proctor Foundation University of California, San Francisco December 4, 2010 No financial disclosures
More informationInflammatory Bowel Disease: Updates and Controversies CASE #1 CASE #1 8/6/2015. What is the most likely diagnosis?
Inflammatory Bowel Disease: Updates and Controversies Tehttp://192.185.93.102/~paulkeij/wpcontent/uploads/2013/07/collaboration.jpgxt August 7, 2015 Meagan M Costedio, MD; Colorectal Surgery; Cleveland
More informationManagement of the Hospitalized IBD Patient. Drew DuPont MD
Management of the Hospitalized IBD Patient Drew DuPont MD Ulcerative Colitis: Indications for Admission Severe ulcerative colitis Frequent loose bloody stools ( 6 per day) Severe cramps Systemic toxicity:
More informationTreatment Goals. Current Therapeutic Pyramids Crohn s Disease Ulcerative Colitis 11/14/10
Current Management of IBD: From Conventional Agents to Biologics Stephen B. Hanauer, M.D. University of Chicago Treatment Goals Induce and maintain response/ remission Prevent complications Improve quality
More informationCoverage Criteria: Express Scripts, Inc. monograph dated 12/15/ months or as otherwise noted by indication
BENEFIT DESCRIPTION AND LIMITATIONS OF COVERAGE ITEM: PRODUCT LINES: COVERED UNDER: DESCRIPTION: CPT/HCPCS Code: Company Supplying: Setting: Kineret (anakinra subcutaneous injection) Commercial HMO/PPO/CDHP
More informationPerianal and Fistulizing Crohn s Disease: Tough Management Decisions. Jean-Paul Achkar, M.D. Kenneth Rainin Chair for IBD Research Cleveland Clinic
Perianal and Fistulizing Crohn s Disease: Tough Management Decisions Jean-Paul Achkar, M.D. Kenneth Rainin Chair for IBD Research Cleveland Clinic Talk Overview Background Assessment and Classification
More informationUlcerative Colitis Therapy. Faculty Disclosure. Acknowledgements 28/11/2013. Amy Morse November 30/13
Ulcerative Colitis Therapy Amy Morse November 30/13 GI for GP s Jasper AB Faculty Disclosure Faculty: Amy Morse Relationships with commercial interests: Grants/Research Support: Therapeutic Fellowship
More informationPositioning Biologics in Ulcerative Colitis
Positioning Biologics in Ulcerative Colitis Bruce E. Sands, MD, MS Acting Chief, Gastrointestinal Unit Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Sequential Therapies
More informationPrevalence, risk factors and response to treatment of extra-intestinal manifestations in patients with inflammatory bowel disease
1130-0108/2017/109/9/627-633 Revista Española de Enfermedades Digestivas Copyright 2017. SEPD y ARÁN EDICIONES, S.L. Rev Esp Enferm Dig 2017, Vol. 109, N.º 9, pp. 627-633 ORIGINAL PAPERS Prevalence, risk
More informationSpeaker Introduction
Speaker Introduction Stephen B. Hanauer, MD Professor of Medicine and Clinical Pharmacology University of Chicago Pritzker School of Medicine Chief of Gastroenterology, Hepatology, and Nutrition University
More informationChronic Granulomatous Disease Managing GI Issues
Chronic Granulomatous Disease Managing GI Issues N I C H O L A S H A R T O G, M D D i r e c t o r o f P e d i a t r i c / A d u l t P r i m a r y I m m u n o d e f i c i e n c y C l i n i c A s s i s t
More informationSurgical Therapies for the Treatment of IBD!
Surgical Therapies for the Treatment of IBD! Andrew A Shelton, MD Clinical Professor of Surgery Stanford Hospital and Clinics Section of Colon and Rectal Surgery! Ulcerative Colitis v. Crohn s! 30% of
More informationPercent Cumulative. Probability. Penetrating. Inflammatory. Stricturing. Months Patients at risk N =
Fistulizing Crohn s Disease Edward V. Loftus, Jr., M.D. Professor of Medicine Division of Gastroenterology & Hepatology Mayo Clinic Rochester, Minnesota, USA Outline Fistulizing Crohn s Etiology Incidence
More informationTitle: Prevalence, risk factors and response to treatment of extra-intestinal manifestations in patients with inflammatory bowel disease
Title: Prevalence, risk factors and response to treatment of extra-intestinal manifestations in patients with inflammatory bowel disease Authors: María Hernández-Tejero, Alicia Granja Navacerrada, Pilar
More informationAdalimumab Therapy for Recalcitrant Pyoderma Gangrenosum
Adalimumab Therapy for Recalcitrant Pyoderma Gangrenosum Margaret A. Fonder, BS, Deborah L. Cummins, MD, Benjamin D Ehst, MD, PhD, Grant J. Anhalt, MD, and Jon H. Meyerle, MD From the Department of Dermatology,
More informationAPPLICATION FOR SPECIAL AUTHORITY. Subsidy for Infliximab
APPLICATION FOR SPECIAL AUTHORITY Fm SA1778 Subsidy f Infliximab Application Categy Page Graft vs host disease - Initial application... 2 Pulmonary sarcoidosis - Initial application... 2 Previous use -
More information3. Has the patient shown improvement in signs and symptoms of the disease? Y N
Pharmacy Prior Authorization MERC CARE (MEDICAID) Renflexis (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax
More informationUnderstanding Inflammatory Bowel Diseases (IBD):
Understanding Inflammatory Bowel Diseases (IBD): What Every Patient Needs to Know William H Holderman, MD Digestive Health Specialists Tacoma, WA Today s Objectives Define IBD, its potential causes and
More information2. Does the patient have a diagnosis of ulcerative colitis or Crohn s? Y N
Pharmacy Prior Authorization AETA BETTER HEALTH LOUISIAA (MEDICAID) Remicade (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign
More informationEvolving therapies for posterior uveitis. Infliximab (Remicade) Infliximab: pharmacology. FDA-approved monoclonal antibody therapy Target
Evolving therapies for posterior uveitis Sam Dahr, M.D. September 17, 2005 Midwest Ophthalmology Conference Infliximab (Remicade) FDA approved for Crohn s disease, rheumatoid arthritis, and psoriatic arthritis
More informationCrohn's Disease. The What, When, and Why of Treatment
Crohn's Disease The What, When, and Why of Treatment Brian Feagan, MD, FACG Professor of Medicine and Epidemiology and Biostatistics Director, Robarts Clinical Trials Robarts Research Institute University
More informationInflammatory Bowel Disease
Inflammatory Bowel Disease William Sonnenberg, MD Titusville, PA Disclosure Dr. William Sonnenberg has no conflict of interest, financial agreement, or working affiliation with any group or organization.
More informationCrohn's Disease. The What, When, and Why of Treatment
Crohn's Disease The What, When, and Why of Treatment Sunanda Kane, MD, FACG Professor of Medicine Department of Gastroenterology and Hepatology Mayo Clinic Rochester, MN In my lecture today, I will be
More informationCase 1. Debridement Cultures Keflex Silvadene
The Red Breast Beth McLellan, M.D. Assistant Professor Division of Dermatology Albert Einstein College of Medicine Montefiore Medical Center Jacobi Medical Center Case 1 48 year old radiation oncologist
More informationSeptember 12, 2015 Millie D. Long MD, MPH, FACG
Update on Biologic Therapy in 2015 September 12, 2015 Millie D. Long MD, MPH, FACG Assistant Professor of Medicine Inflammatory Bowel Disease Center University of North Carolina-Chapel Hill Outline Crohn
More informationSuperficial Granulomatous Pyoderma of the Face: A Case Report and Review of the Literature
Superficial Granulomatous Pyoderma of the Face: A Case Report and Review of the Literature Sarah M. Persing, MPH, a and Donald Laub Jr, MD, FACS a,b a University of Vermont College of Medicine, Burlington;
More informationAli Keshavarzian MD Rush University Medical Center
Treatment: Step Up or Top Down? Ali Keshavarzian MD Rush University Medical Center Questions What medication should IBD be treated with? Can we predict which patients with IBD are high risk? Is starting
More informationDr. Elmer Schabel, MD. Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany (No conflicts of interest)
EMA workshop on the development of new medicinal products for the treatment of ulcerative colitis and Crohn s disease Overview of authorised medicines for IBD in Europe - previous regulatory positions
More informationBehçet s Disease: The American Perspectivecan Pers. Disclosures. Learning Objectives 4/16/2018
Behçet s Disease: The American Perspectivecan Pers Cailin Sibley, M.D., M.H.S. Director, Vasculitis Clinic April 27 th, 2018 NTEREST DISCLOSURE Disclosures As no medications to treat Behçet s disease are
More informationHumira (adalimumab) DRUG.00002
Humira (adalimumab) DRUG.00002 Override(s) Prior Authorization Quantity Limit Approval Duration 1 year Medications Humira 10 mg/0.2 ml syringe Humira pediatric Crohn s Disease starter pack 40 mg/0.8 ml
More informationPrior Authorization Conditions for Approval of Humira (adalimumab) Website Form Submit request via: Fax
Prior Authorization Conditions for Approval of Humira (adalimumab) Website Form www.highmarkhealthoptions.com Submit request via: Fax - 1-855-476-4158 All requests for Humira (adalimumab) require a prior
More informationDiarrhoea for the Acute Physician
Diarrhoea for the Acute Physician STEPHEN INNS GASTROENTEROLOGIST AND PHYSICIAN HUTT VALLEY DHB August 2013 Outline Case History 1 Initial assessment of acute diarrhoea Management of fulminant UC Management
More informationSkin cancers in patients treated with immunomodulating drugs. Manuelle Viguier, MD, PhD Dermatology department Saint-Louis Hospital Paris, France
Skin cancers in patients treated with immunomodulating drugs Manuelle Viguier, MD, PhD Dermatology department Saint-Louis Hospital Paris, France Immunomodulating drugs used in Methotrexate Mycophenolate
More informationRemicade (infliximab) DRUG.00002
Applicability/Effective Date *- Florida Healthy Kids Remicade (infliximab) DRUG.00002 Override(s) Prior Authorization Step Therapy Medications Remicade (infliximab) Approval Duration 1 year Comment Intravenous
More informationRegulatory Status FDA-approved indication: Humira and Amjevita are tumor necrosis factor (TNF) blockers indicated for the treatment of: (2-3)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.29 Subject: Humira Page: 1 of 10 Last Review Date: June 22, 2017 Humira Description Humira (adalimumab),
More information2. Has the patient had a response to treatment? Y N. 3. Does the patient have a diagnosis of rheumatoid arthritis (RA)? Y N
12/21/2016 Prior Authorization Aetna Better Health of West Virginia Humira (WV88) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and
More information1. Background: Infliximab is administered parenterally; therefore, it is not covered under retail pharmacy benefits.
Subject: Infliximab (Remicade ) Original Original Committee Approval: October 13, 2006 Revised Last Committee Approval: December 3, 2008 Last Review: October 19, 2007 1. Background: Infliximab is a genetically
More informationFrequency of pathergy phenomenon and other features of Behçet s syndrome among patients with inflammatory bowel disease
Frequency of pathergy phenomenon and other features of Behçet s syndrome among patients with inflammatory bowel disease I. Hatemi 1, G. Hatemi 2, A. F. Celik 1, M. Melikoglu 2, N. Arzuhal 3, C. Mat 3,
More informationInflectra Frequently Asked Questions
Inflectra Frequently Asked Questions 1. What is the funding status of Inflectra (infliximab)? Earlier in 2016, Inflectra (infliximab) was added to the Ontario Drug Benefit (ODB) Formulary as a Limited
More informationIndications for use of Infliximab
Indications for use of Infliximab Moscow, June 10 th 2006 Prof. Dr. Dr. Gerhard Rogler Klinik und Poliklinik für Innere Medizin I Universität Regensburg Case report 1989: Diagnosis of Crohn s disease of
More informationColostomy & Ileostomy
Colostomy & Ileostomy Indications, problems and preference By Waleed Omar Professor of Colorectal surgery, Mansoura University. Disclosure I have no disclosures. Presentation outline Stoma: Definition
More informationIBD Understanding Your Medications. Thomas V. Aguirre, MD Santa Barbara GI Consultants
IBD Understanding Your Medications Thomas V. Aguirre, MD Santa Barbara GI Consultants IBD Understanding Your Medications (& Your Doctor) Thomas V. Aguirre, MD Santa Barbara GI Consultants Disclosure I
More informationRemicade (infliximab) Inflectra (infliximab-dyyb) Renflexis (infliximab-abda)
DRUG POLICY BENEFIT APPLICATION Remicade (infliximab) Inflectra (infliximab-dyyb) Renflexis (infliximab-abda) Benefit determinations are based on the applicable contract language in effect at the time
More informationMedical Therapy for Pediatric IBD: Efficacy and Safety
Medical Therapy for Pediatric IBD: Efficacy and Safety Betsy Maxwell, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Pediatric IBD: Defining Remission
More informationWelcome to Week 2 of the Crohn s & Colitis Foundation of America (CCFA) Online Support Group.
Welcome to Week 2 of the Crohn s & Colitis Foundation of America (CCFA) Online. Last week s material consisted of an overview of inflammatory bowel diseases (IBD), specifically Crohn s disease and ulcerative
More informationCutaneous Manifestations in Inflammatory Bowel Diseases
Journal of Mind and Medical Sciences Volume 2 Issue 2 Article 2 2015 Cutaneous Manifestations in Inflammatory Bowel Diseases Simona Roxana Georgescu Carol Davila University of Medicine and Pharmacy, simonaroxanageorgescu@yahoo.com
More informationFistulizing Crohn s Disease: The Aggressive Approach
Fistulizing Crohn s Disease: The Aggressive Approach Bruce E. Sands, MD, MS MGH Crohn s and Colitis Center and Gastrointestinal Unit Massachusetts General Hospital Boston, USA Case Presentation: Summary
More informationCCFA. Crohns Disease vs UC: What is the best treatment for me? November
CCFA Crohns Disease vs UC: What is the best treatment for me? November 8 2009 Ellen J. Scherl,, MD, FACP,AGAF Roberts Inflammatory Bowel Disease Center Weill Medical College Cornell University New York
More information