IBD and Cancer: Myths and Facts
|
|
|
- Warren Bruce
- 6 years ago
- Views:
Transcription
1 IBD and Cancer: Myths and Facts Thomas A. Ullman, MD Medical Director, Faculty Prac>ce Department of Medicine Icahn School of Medicine at Mount Sinai New York, USA
2
3 Risk of Colorectal Cancer in UC Eaden et al. Gut 48:526, 2001
4 Risk of Colorectal Cancer in Crohn s Crohn s Canavan, APT, 2006
5 Colorectal Cancer in IBD: Factors that Increase Risk Dura>on >8-10 years Extent of coli>s: Extensive disease Backwash ilei>s Family history of colon cancer Primary sclerosing cholangi>s Early age at onset of coli>s Histologic ac>vity Pseudopolyps Dysplasia at surveillance
6 Colorectal Cancer in IBD: Factors that Decrease Risk Prophylac>c Colectomy Regular doctor visits (and the unknown) Surveillance colonoscopy Timely surgery/lesion removal Adjunc>ve colonoscopic techniques Chemopreven>on? Mesalamines? UDCA Yes (PSC pts/low dose) Folic Acid? 6MP/Azathioprine?
7 Cancer Surveillance in Colitis Inflammation Dysplasia Cancer Death Initiate screening and surveillance Intervention to prevent further progression: surgery
8 So are we decreasing CRC morbidity and mortality in IBD?
9 Is the Curve Changing with Surveillance? Eaden et al. Gut 48:526, 2001 Ullman, et al. CGH 6:1225, 2008
10
11
12 Has Colitis-Related CRC Declined in Importance? SMR 95% CI Copenhagen, Denmark Olmsted, MN, USA Winther, CGH 2004;2: Jess, Gastro 2006;130:
13 Do Medicines for IBD Cause Cancer?
14 What are the main side-effects of 6MP/ Azathioprine? Event Frequency Estimate Stop therapy due to AE 11% Allergic reactions 2% Nausea 2% Hepatitis 2% Pancreatitis 3% Serious infections 5% non-hodgkin s lymphoma 0.04%-0.09% (4-9/10,000) Siegel CA, et al. APT 2005 (weighted average); Siegel CA, et al. CGH 2009; Beaugerie L, et al. Lancet 2009.
15 Solid tumors and 6MP/Azathioprine in IBD (non-gi and non-skin cancers) Study Types of cancer Number of patients Statistically significant Armstrong 2010 lung, breast 1955 NO Fraser 2002 Connell 1994 breast, bronchial, renal gastric, lung, breast, cervical 6262 NO 755 NO No clear association between thiopurines and solid tumors in IBD
16 Risk of Skin Cancer Associated with Thiopurines 19,486 IBD patients in CESAME cohort 32 cases of skin cancer (20 basal cell, 12 squamous) Look at denominator (" Incidence rate per 1000 ptyears '" &" %" $" -./012(/3&)$ &6$ -./012(/3&)$ 6/)403532&6$ 7&8&($ 9./012(/3&)$ Wear sunscreen Regular skin checks #"!"!"#$%&'()$ "#*+"$%&'()$,+"$%&'()$ Peyrin-Biroulet L, et al. Gastroenterology 2011
17 Adverse Events Associated with anti-tnf Treatment Event Stop therapy due to adverse event Siegel CA.. The inflammatory bowel disease yearbook, volume ; Infliximab package insert; Vermeire, Gastro 2003; Cush, Ann Rheum Dis 2005; Lenercept study group, Neurology 1999; ATTACH trial 2003 Estimated Frequency 10% Infusion or injection site reactions 3%-20% Drug related lupus-like reaction 1% Serious infections 3% Tuberculosis 0.05% (5/10,000) Non-Hodgkin s lymphoma (combo) Multiple sclerosis, heart failure, serious liver injury 0.06% (6/10,000) Case reports only
18 Risk of NH Lymphoma with anti-tnf + IM treatment for Crohn s Disease: A Meta-Analysis 8905 patients representing 20,602 pt-years of exposure 13 Non-Hodgkin s lymphomas à 6.1 per 10,000 pt-years Mean age 52, 62% male 10/13 exposed to IM* (really a study of combo Rx) NHL rate per 10,000 SIR 95% CI SEER all ages IM alone Anti-TNF + IM vs SEER Anti-TNF+ IM vs IM alone Siegel et al, CGH 2009;7:874. *not reported in 2
19 Risk of Developing non-hodgkin s Lymphoma Patient receiving Immunomodulator +/- anti-tnf Therapy for 1 year Risk without of lymphoma medication with immune suppression Siegel CA, Inflamm Bowel Dis 2010;16:2168.
20 Solid Tumors and anti-tnf in RA National Data Bank for Rheumatic Diseases ( ) 13,000 patients enrolled, 49% received biologics Type of Cancer Odds Ratio All cancers 1.0 ( ) All solid tumors 1.0 ( ) Colon 0.8 ( ) Lung 1.1 ( ) Breast 0.9 ( ) Pancreas 0.5 ( ) Melanoma 2.3 ( ) Non-melanoma skin 1.5 ( ) Wolfe, Arthritis and Rheumatism 2007;56:2886.
21 RA PaDents Treated with AnD- TNF: Similar Stage and Survival as Those without AnD- TNF Cohort of 78,483 RA patients 8,562 started therapy with a biologic agent 98% anti-tnf 314 cancers in patients undergoing or with a history of treatment with biologic 4,650 cancers in biologics-naïve patients Outcomes: Tumor stage at time of diagnosis Post cancer survival Raaschou et al. Arthri's & Rheuma'sm ;
22 No overall difference in mortality or stage at diagnosis related to and- TNF exposure Raaschou et al. Arthri's & Rheuma'sm ;
23 What if I Have a History of Cancer?
24 IBD pts with history of cancer: Thiopurine Exposure - No Increased Risk of Subsequent Cancer (CESAME) 19,486 pts with IBD: Enrolled May 2004-June 2005, followed through December with personal history of cancer with at least one follow up visit Compared risk of developing new/recurrent cancer: 93 pts exposed to IT (thiopurine): 6 new cancers 1 recurrence of meningioma 312 not exposed to IT 12 new cancers 4 recurrent cancers (lymphoma, breast, prostate, small bowel) IT Naïve at Entry n=312 IT at Entry n=93 New Cancer (NS) 14.4/1000 PY 23.1/1000 PY Recurrent Cancer (NS) 6.8/1000 PY 3.9/1000 PY P=0.98 P=0.26 L Beaugerie et al. Abstract DDW 2012.
25 RA PaDents with History of Cancer: AnD- TNF Treatment Did Not Increase Risk of New or Recurrent Cancer (BriDsh Registry) Over 14,000 pts with RA 293 with prior malignancy 177 anti-tnf treated 117 DMARD treated (no anti-tnf) Rates of incident malignancy compared 25.3/1000 PY in anti-tnf 38.3/1000 PY in DMARD Prior Melanoma: 3/17 (18%) in anti-tnf developed incident malignancy 0/10 (0%) in DMARD developed incident malignancy BSR Guidelines at Dme of study read: CauDon should be exercised.in pts with previous malignancy If pts have been free of any recurrence of their malignancy for 10 yrs there is no evidence for a contraindicadon to and- TNF therapy DMARD AnD- TNF Dixon et al., Arthritis Care & Research ;
26 RA Patients with History of Cancer: Anti-TNF Treatment Did Not Increase Risk of New or Recurrent Cancer (German Registry) Biologic or conventional DMARD therapy between May 2001 and December 2006 Prior malignancy in 122 out of 5,120 pts 58 pts received anti-tnf 55 conventional DMARDs 14 pts exposed to anti-tnf with 15 recurrent cancers Crude recurrence rates: 45.5/1000 PY in anti-tnf exposed 31.4/1000 PY in DMARD exposed Incidence rate ratio 1.4 (P=0.6) Strangfeld et al. Arthri's Research &Therapy :R5.
27 Summary There is an increased risk of colorectal cancer in IBD With surveillance, time and other factors that risk is about the same as the general population: GET YOUR SURVEILLANCE Some medicines increase the chance of lymphoma, but it is a very small risk 6MP/Azathioprine increase the risk for non-melanoma skin cancer Anti-TNF s may increase the risk for melanoma Those same medicines don t seem to increase the risk of other cancers
Communicating with the IBD Patient: How to convey risks and benefits
Communicating with the IBD Patient: How to convey risks and benefits October 30, 2011 ACG Postgraduate Course National Harbor, Maryland Corey A. Siegel, MD Assistant Professor of Medicine Dartmouth Medical
Azathioprine for Induction and Maintenance of Remission in Crohn s Disease
Azathioprine for Induction and Maintenance of Remission in Crohn s Disease William J. Sandborn, MD Chief, Division of Gastroenterology Director, UCSD IBD Center Objectives Azathioprine as induction and
Risk = probability x consequence
Explaining Risks of IBD Therapy to Parents and Patients December 4, 2009 CCFA Advances in IBD Hollywood, FL Corey A. Siegel Assistant Professor of Medicine, Dartmouth Medical School Director, Dartmouth-Hitchcock
Malignancy Risk in Pediatric IBD: What to tell parents and patients?
Malignancy Risk in Pediatric IBD: What to tell parents and patients? Corey A. Siegel, MD, MS Geisel School of Medicine at Dartmouth Dartmouth-Hitchcock Medical Center Digestive Disease Week 2017 Chicago,
Addressing Risks and Benefits In IBD
Addressing Risks and Benefits In IBD Gil Y. Melmed, MD, MS Assistant Professor of Medicine, Cedars-Sinai Medical Center David Geffen School of Medicine at UCLA www.nomorecrohnsdisease.com "Jaw Dropping
Cancer Risk with IBD Therapies How to Discuss with your Patients?
Cancer Risk with IBD Therapies How to Discuss with your Patients? Douglas L Nguyen, MD Assistant Clinical Professor of Medicine University of California, Irvine Medical Center H.H. Chao Comprehensive Digestive
IBD high risk groups
IBD high risk groups Ulcerative colitis Value (95% CI) CRC prevalence (%) 3.7 (3.2-4.2) Overall annual CRC incidence (%) 0.3 (0.2-0.4) Annual CRC incidence in first decade of UC (%) 0.2 (0.1-0.2) Annual
CRC and Dysplasia in IBD: Objectives of Talk. Colorectal Cancer and Dysplasia in IBD: A Case-Based Approach. Page 1
Colorectal Cancer and in IBD: A Case-Based Approach Fernando Velayos MD MPH Associate Director of Translational Research University of California, San Francisco Center for Crohn s s and Colitis CRC and
Initiation of Maintenance Treatment in Moderate to Severe New Onset Crohn s Disease
Initiation of Maintenance Treatment in Moderate to Severe New Onset Crohn s Disease The Case for Starting with Anti-TNFα Agents Maria Oliva-Hemker, M.D. Chief, Division of Pediatric Gastroenterology &
IBD 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
Predicting the natural history of IBD. Séverine Vermeire, MD, PhD Department of Gastroenterology University Hospital Leuven Belgium
Predicting the natural history of IBD Séverine Vermeire, MD, PhD Department of Gastroenterology University Hospital Leuven Belgium Patient 1 Patient 2 Age 22 Frequent cramps and diarrhea for 6 months Weight
Staying Healthy as an IBD patient
Staying Healthy as an IBD patient Crohn s & Colitis Seattle Education Conference March 28, 2015 Karlee Ausk, MD Swedish Gastroenterology Epidemiology Affects >1.4 million Americans Economic burden $2.8
Can We Predict the Natural History of Ulcerative Colitis? Edward V Loftus, Jr, MD Professor of Medicine Mayo Clinic Rochester, Minnesota, USA
Can We Predict the Natural History of Ulcerative Colitis? Edward V Loftus, Jr, MD Professor of Medicine Mayo Clinic Rochester, Minnesota, USA Endpoints Overview Hospitalization Surgery Colorectal cancer
Page 1. Is the Risk This High? Dysplasia in the IBD Patient. Dysplasia in the Non IBD Patient. Increased Risk of CRC in Ulcerative Colitis
Screening for Colorectal Neoplasia in Inflammatory Bowel Disease Francis A. Farraye MD, MSc Clinical Director, Section of Gastroenterology Co-Director, Center for Digestive Disorders Boston Medical Center
Microbiome, Inflammation and Cancer
Microbiome, Inflammation and Cancer Anita Afzali MD, MPH, FACG Medical Director, OSU Inflammatory Bowel Disease Center Abercrombie & Fitch Endowed Chair in Inflammatory Bowel Disease 4 th Annual Cancer
Adverse Events From Biologic Agents in IBD
Adverse Events From Biologic Agents in IBD David A. Schwartz, MD, FACG Director, Inflammatory Bowel Disease Center Professor of Medicine Vanderbilt University Medical Center Case Page 1 of 24 28 yo with
Ulcerative Colitis: Refining our Management and Incorporating Newer Concepts
Ulcerative Colitis: Refining our Management and Incorporating Newer Concepts Asher Kornbluth, MD Clinical Professor of Medicine The Henry D. Janowitz The Mt. Sinai School of Medicine Refining our Management
Efficacy 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,
CASE DISCUSSION: The Patient with Dysplasia: Surgery or Active Surveillance? Noa Krugliak Cleveland, MD David T. Rubin, MD
CASE DISCUSSION: The Patient with Dysplasia: Surgery or Active Surveillance? Noa Krugliak Cleveland, MD David T. Rubin, MD Disclosure Statement NKC: No relevant conflicts to disclose. DTR: No relevant
Medical 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
Practical Risk Management Tools for Patients with IBD. Garth Swanson MD Rush University Medical Center
Practical Risk Management Tools for Patients with IBD Garth Swanson MD Rush University Medical Center IBD Therapy Severity Tysabri Surgery Infliximab, i Adalimumab, Certilizumab Corticosteroids, Immunomodulators
Management of patients with should not use past or present history of solid cancer
Practical management of patients receiving abatacept 1 Management of patients with should not use past or present history of solid Evidence-based Medicine Official Recommendations Expert opinion Steps
WHY HAVE WE NOT FINALLY FIGURED OUT COMBINATION THERAPY?
WHY HAVE WE NOT FINALLY FIGURED OUT COMBINATION THERAPY? Siew Ng, Professor MBBS, FRCP, (Lon, Edin), PhD (Lond), AGAF, FHKCP, FHKAM (medicine) Department of Medicine and Therapeutics Chinese University
Skin 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
Diagnostic techniques for surveillance of dysplasia
January 27th 2017, 8th Gastro Foundation Weekend for Fellows; Spier Hotel & Conference Centre, Stellenbosch Diagnostic techniques for surveillance of dysplasia Gerhard Rogler, Department of Gastroenterology
Improving outcome of Inflammatory Bowel Disease in children
Improving outcome of Inflammatory Bowel Disease in children Dinesh Pashankar, MD Pediatric Gastroenterologist Director- Pediatric IBD program Yale University School of Medicine Pediatric Gastroenterology
Position of Biologics in IBD Circa 2006: Top Down vs. Step Up Therapy
Position of Biologics in IBD Circa 2006: Top Down vs. Step Up Therapy Stephen B. Hanauer, MD University of Chicago Potential Conflicts: Centocor/Schering, Abbott, UCB, Elan, Berlex, PDL Goals of Treatment
Top 10 Things you need to know about IBD. Suresh Pola, MD Kaiser San Diego
Top 10 Things you need to know about IBD Suresh Pola, MD Kaiser San Diego Top 10 Things to Know: IBD What you can eat How to treat the pain Not all diarrhea is a flare Ways to reduce your risk of getting
AAIM: GI Workshop Follow Up to Case Studies. Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease
AAIM: GI Workshop Follow Up to Case Studies Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease Daniel Zimmerman, MD VP and Medical Director, RGA Global October 2015 Non-alcoholic Fatty
Review article: the incidence and prevalence of colorectal cancer in inflammatory bowel disease
Aliment Pharmacol Ther 23; 18 (Suppl. 2): 1 5. Review article: the incidence and prevalence of colorectal cancer in inflammatory bowel disease P. MUNKHOLM Department of Medical Gastroenterology, Hvidovre
CANCER SCREENING IN IBD David T. Rubin, MD, FACG
1C: Advances in Inflammatory Bowel Disease CANCER SCREENING IN IBD David T. Rubin, MD, FACG Risk Factors for Neoplasia in Chronic Colitis An increasing amount of evidence has provided a link between chronically
Chromoendoscopy or Narrow Band Imaging with Targeted biopsies Should be the Cancer Surveillance Endoscopy Procedure of Choice in Ulcerative Colitis
Chromoendoscopy or Narrow Band Imaging with Targeted biopsies Should be the Cancer Surveillance Endoscopy Procedure of Choice in Ulcerative Colitis Bret A. Lashner, M.D. Professor of Medicine Director,
Diagnostic and Therapeutic Approaches to Dysplasia in Inflammatory Bowel Diseases
Diagnostic and Therapeutic Approaches to Dysplasia in Inflammatory Bowel Diseases Parakkal Deepak, M.B.B.S., M.S. Assistant Professor of Medicine Division of Gastroenterology John T. Milliken Department
Treatment 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.
Withdrawal of drug therapy in patients with quiescent Crohn s disease
Withdrawal of drug therapy in patients with quiescent Crohn s disease DR. JEAN-FRÉDÉRIC COLOMBEL DIRECTOR OF THE IBD CENTER, ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI, NEW YORK, USA Withdrawal of drug therapy
Dysplasia 4/19/2017. How do I practice Chromoendoscopy for Surveillance of Colitis? SCENIC: Polypoid Dysplasia in UC. Background
SCENIC: Polypoid in UC Definition How do I practice for Surveillance of Colitis? Themos Dassopoulos, M.D. Director, BSW Center for IBD Themistocles.Dassopoulos@BSWHealth.org Tel: 469-800-7189 Cell: 314-686-2623
Outline. Biologic Drugs in Inflammatory Bowel Disease Dr. Jason Etzel MD The Vancouver Clinic. Biologic Drugs. Biologic Drugs. Biologic Drugs Anti-TNF
Outline Biologic Drugs in Inflammatory Bowel Disease Dr. Jason Etzel MD The Vancouver Clinic Types of biologic drugs How do they work? How effective are they? Safety/Toxicity concerns with biologics Biologic
Positioning 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
SURGICAL 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
Mucosal healing: does it really matter?
Oxford Inflammatory Bowel Disease MasterClass Mucosal healing: does it really matter? Professor Jean-Frédéric Colombel, New York, USA Oxford Inflammatory Bowel Disease MasterClass Mucosal healing: does
Balancing the Risk and Benefit of Immunomodulator and Biologic Therapy in Patients with IBD
Balancing the Risk and Benefit of Immunomodulator and Biologic Therapy in Patients with IBD Gary R. Lichtenstein, MD Professor of Medicine University of Pennsylvania School of Medicine Director, Center
PEDIATRIC 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
Indications 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
Pregnancy in IBD CDDW 2014
Pregnancy in IBD CDDW 2014 Brian Bressler MD, MS, FRCPC Director, Advanced IBD Training Program Clinical Assistant Professor of Medicine Division of Gastroenterology University of British Columbia Bressler
Optimizing the effectiveness of anti-tnf therapy in paediatric IBD
Optimizing the effectiveness of anti-tnf therapy in paediatric IBD Anne Griffiths MD, FRCPC Co-Lead, Inflammatory Bowel Disease Center Northbridge Chair in IBD Hospital for Sick Children, Professor of
Dr David Rowbotham. The Leeds Teaching Hospitals NHS Trust NHS
Dr David Rowbotham The Leeds Teaching Hospitals NHS Trust NHS Useful Titbits from the World of Gastroenterology David Rowbotham Clinical Director & Consultant Gastroenterologist Dept of Gastroenterology
Diagnostic Ionizing Radiation Exposure in a Population-Based Cohort of Children with Inflammatory Bowel Disease
Diagnostic Ionizing Radiation Exposure in a Population-Based Cohort of Children with Inflammatory Bowel Disease Lena B. Palmer MD, Carol Q. Porter, Michael D. Kappelman MD MPH No relevant financial disclosures
IBD-Related Lymphoma
IBD-Related Lymphoma Larry Burgart MD Staff Pathologist, Allina Health and Minnesota Gastroenterology Clinical Professor of Pathology, University of Minnesota College of Medicine IBD-Related Lymphoma
Epidemiology / 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
Of Treatment For Inflammatory Bowel Diseases
Balancing The Risks And Benefits Of Treatment For Inflammatory Bowel Diseases Corey A. Siegel, MD Assistant Professor of Medicine Dartmouth Medical School Director, Inflammatory Bowel Diseases Center Dartmouth-Hitchcock
Optimizing Therapies for Severe Ulcerative Colitis October 19, 2014
Optimizing Therapies for Severe Ulcerative Colitis October 19, 2014 Ellen J. Scherl, MD, FACP, FACG, AGAF, FASGE, NYSGEF Director Jill Roberts Center for Inflammatory Bowel Disease Jill Roberts IBD Research
Anti-TNF and cyclosporine are identical choices for severe ulcerative colitis refractory to steroid therapy CON Peter Laszlo LAKATOS Semmelweis
Anti-TNF and cyclosporine are identical choices for severe ulcerative colitis refractory to steroid therapy CON Peter Laszlo LAKATOS Semmelweis University, 1st Department of Medicine Budapest June 13-15,
Available Data on Pediatric Exposure Response a Clinician s Perspective
Available Data on Pediatric Exposure Response a Clinician s Perspective Marla Dubinsky, MD Professor of Pediatrics and Medicine Chief Pediatric GI and Nutrition Co-Director Susan and Leonard Feinstein
Prevention of Complications from IBD Therapies
Prevention of Complications from IBD Therapies July 23, 2011 Millie D. Long MD, MPH Inflammatory Bowel Diseases Center University of North Carolina-Chapel Hill Outline: Complications of IBD Therapies Osteoporosis
Personalized Medicine in IBD: Where Are We in 2013
Personalized Medicine in IBD: Where Are We in 2013 David A. Schwartz, MD Director, Inflammatory Bowel Disease Center Associate Professor of Medicine Vanderbilt University Medical Center What is Personalized
To help protect your privacy, PowerPoint prevented this external picture from being automatically downloaded. To download and display this picture,
To help protect your privacy, PowerPoint prevented this external picture from being automatically downloaded. To download and display this picture, click Options in the Message Bar, and then click Enable
Drugs and Applicable Coding: J-code: Enbrel-J1438; Humira-J0135; Remicade-J1745; Inflectra-Q5102; Cimzia-J0718; Simponi-J1602 Renflexis - pending
Policy Subject: Anti-TNF Agents Policy Number: SHS PBD16 Category: Rheumatology & Autoimmune Policy Type: Medical Pharmacy Department: Pharmacy Product (check all that apply): Group HMO/POS Individual
Moderately 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
Biologics: Too Risky
Biologics: Too Risky Sharmeel K. Wasan, MD, FACG Assistant Professor of Medicine Boston University School of Medicine Why Anti-TNF Therapy? CD patients have long-term risk of intestinal resection (80%)
removal of adenomatous polyps detects important effectively as follow-up colonoscopy after both constitute a low-risk Patients with 1 or 2
Supplementary Table 1. Study Characteristics Author, yr Design Winawer et al., 6 1993 National Polyp Study Jorgensen et al., 9 1995 Funen Adenoma Follow-up Study USA Multi-center, RCT for timing of surveillance
CCFA. 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
Are Biologicals Safe Enough?
Are Biologicals Safe Enough? Dr Anne Duggan Director of Gastroenterology, John Hunter Hospital, Hunter New England Area Health Service (HNEAHS) Conjoint A/Professor, University of Newcastle, Australia
Crohn'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
IBD Case Studies. David Rowbotham. Clinical Director & Consultant Gastroenterologist Dept of Gastroenterology & Hepatology Auckland City Hospital
IBD Case Studies David Rowbotham Clinical Director & Consultant Gastroenterologist Dept of Gastroenterology & Hepatology Auckland City Hospital Dr David Rowbotham The Leeds Teaching Hospitals NHS Trust
Oxford Inflammatory Bowel Disease MasterClass. What is early IBD? Prof. Laurent Peyrin-Biroulet Head, IBD Unit Nancy University Hospital, France
Oxford Inflammatory Bowel Disease MasterClass What is early IBD? Prof. Laurent Peyrin-Biroulet Head, IBD Unit Nancy University Hospital, France Disclosures Consulting and/or lecture fees from Merck, Abbott,
ExtraintestinalManifestations 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
Crohn'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
Looking for Answers. IBD Research March 9, Dr. Benjamin Click, MD MS Associate Staff Cleveland Clinic
Looking for Answers IBD Research 2019 March 9, 2019 Dr. Benjamin Click, MD MS Associate Staff Cleveland Clinic Disclosures No relevant financial disclosures There is still no cure for IBD Why me? ETIOLOGY
Mono or Combination Therapy with. Individualized Approach
Mono Combination Therapy with Biologics i in IBD: Developing an Individualized Approach David T. Rubin, MD, FACG Co-Direct, Inflammaty Bowel Disease Center Fellowship Program Direct University of Chicago
IMPORTANT INFORMATION FOR HEALTHCARE PROFESSIONALS ON SAFETY AND RISK MINIMISATION FOR INFLIXIMAB
This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare Professionals are asked to report any suspected adverse reactions.
Treatment 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
Efficacy 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,
Recent Advances in the Management of Refractory IBD
Recent Advances in the Management of Refractory IBD Raina Shivashankar, M.D. Assistant Professor of Medicine Division of Gastroenterology and Hepatology Thomas Jefferson University Philadelphia, PA Outline
Latest Endoscopic Guidelines for FAP, HNPCC, IBD, and the General Population
Latest Endoscopic Guidelines for FAP, HNPCC, IBD, and the General Population David T. Rubin, M.D. Assistant Professor of Medicine Inflammatory Bowel Disease Center MacLean Center for Clinical Medical Ethics
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Colorectal cancer: colonoscopic surveillance for prevention of colorectal cancer in patients with ulcerative colitis, Crohn
IBD What s in it for you?
Addenbrooke s NHS Trust IBD What s in it for you? Dr Miles Parkes Consultant Gastroenterologist Cambridge What is IBD? - inflammatory bowel disease Ulcerative colitis + Crohn s disease = main forms Incidence
AESOP Overview and Inclusion/Exclusion Criteria Richard Pencek, PhD
747-207 AESOP Overview and Inclusion/ Criteria Richard Pencek, PhD Sr Director, Clinical Research, Intercept Pharmaceuticals, Inc. 2 PSC Forum 2 AESOP: A Phase 2 Randomized, Placebo-Controlled Trial, Dose-Finding
Beyond 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
Biologic Therapy for Inflammatory. Is Top-Down Too Top-Heavy? S. Devi Rampertab, MD, FACG, AGAF Associate Professor of Medicine University of Florida
Biologic Therapy for Inflammatory Bowel Disease: Is Top-Down Too Top-Heavy? S. Devi Rampertab, MD, FACG, AGAF Associate Professor of Medicine University of Florida Learning Objectives Evaluate evidence
Personalized Medicine. Selecting the Right First-line Biologic Agent. Gene Expression Profiles Crohn s Disease. The Right Treatment
Personalized Medicine Selecting the Right First-line Biologic Agent William Tremaine, M.D. Maxine and Jack Zarrow Professor Mayo Clinic Rochester, MN, USA The Right Treatment Pretreatment Genomic Analysis
Chemoprevention of Colorectal Neoplasia in Ulcerative Colitis: The Effect of 6-Mercaptopurine
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:1015 1021 Chemoprevention of Colorectal Neoplasia in Ulcerative Colitis: The Effect of 6-Mercaptopurine SIERRA MATULA,* VICTORIA CROOG,* STEVEN ITZKOWITZ,*
Colorectal Cancer Screening
Colorectal Cancer Screening December 5, 2017 Connecticut Cancer Partnership 14th Annual Meeting Xavier Llor, M.D., PhD. Associate Professor of Medicine Co-Director, Cancer Genetics and Prevention Program
Inflammatory Bowel Disease Causespecific Mortality: A Primer for Clinicians
Inflammatory Bowel Disease Causespecific Mortality: A Primer for Clinicians The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation
Choosing and Positioning Biologic Therapy for Crohn s Disease: (Still) Looking for the Crystal Ball
Choosing and Positioning Biologic Therapy for Crohn s Disease: (Still) Looking for the Crystal Ball Siddharth Singh, MD, MS Assistant Professor of Medicine Division of Gastroenterology Division of Biomedical
Annual European Congress of Rheumatology (EULAR) Madrid, Spain, June 2017
Annual European Congress of Rheumatology (EULAR) 2017 Madrid, Spain, 14-17 June 2017 NEW DATA SUGGEST NO INCREASED CANCER RISK FOR RA PATIENTS PRESCRIBED BIOLOGICAL DMARDS Reassuring findings may positively
Childhood onset inflammatory bowel disease and risk of cancer: a Swedish nationwide cohort study
Childhood onset inflammatory bowel disease and risk of cancer: a Swedish nationwide cohort study 6- O Olén,,, J Askling, MC Sachs, P Frumento, M Neovius, KE Smedby, A Ekbom, P Malmborg,,5 JF Ludvigsson
Optimizing Immunomodulators and
Optimizing Immunomodulators and Biologics i in Inflammatory Bowel Disease Sunanda Kane, MD, MSPH, FACG Professor of Medicine Division of Gastroenterology and Hepatology Mayo Clinic Rochester, Minnesota,
Cost-effectiveness of adenoma surveillance - the Dutch guidelines -
Cost-effectiveness of adenoma surveillance - the Dutch guidelines - WEO working group adenoma surveillance 20 May, 2016 Iris Lansdorp-Vogelaar, PhD On behalf of the SAP study-group Introduction Adenoma
Selection and use of the non-anti- TNF biological therapies: Who? When? How?
Selection and use of the non-anti- TNF biological therapies: Who? When? How? Asher Kornbluth, MD Clinical Professor of Medicine The Henry D. Janowitz Division of Gastroenterology The Icahn School of Medicine
Crohn's Disease. The What, When, and Why of Treatment
Crohn's Disease The What, When, and Why of Treatment Gary R. Lichtenstein, MD, FACG Professor of Medicine Director, Inflammatory Bowel Disease Program University of Pennsylvania Philadelphia, PA In my
Treatment Options. Suresh Pola, MD Kaiser San Diego
Treatment Options Suresh Pola, MD Kaiser San Diego Overview of Treatments! Medications! Diet! Complementary and Alternative Medicines! How to treat Pain Treatment Goals and Target! Goals of Treatment should
Personalized Medicine in IBD
Personalized Medicine in IBD Anita Afzali MD, MPH Assistant Professor of Medicine Director, Inflammatory Bowel Diseases Program University of Washington Harborview Medical Center CCFA April 2 nd, 2016
Aging and Cancer in HIV
Aging and Cancer in HIV Ronald Mitsuyasu, MD Professor of Medicine Director, UCLA Center for Clinical AIDS Research and Education Group Chairman, AIDS Malignancy Consortium (AMC) Age distribution of HIV-infected
Quality of and compliance with colonoscopy in Lynch Syndrome surveillance: are we getting it right?
Quality of and compliance with colonoscopy in Lynch Syndrome surveillance: are we getting it right? Hartery K 1, Sukha A 1, Thomas-Gibson S 1, Thomas H 1,2, Latchford A 1,2. 1 Wolfson Endoscopy Unit, St.
Implementation of disease and safety predictors during disease management in UC
Implementation of disease and safety predictors during disease management in UC DR ARIELLA SHITRIT DIGESTIVE DISEASES INSTITUTE SHAARE ZEDEK MEDICAL CENTER JERUSALEM Case presentation A 52 year old male
Microscopic Colitis. Darrell S. Pardi, MD Inflammatory Bowel Disease Clinic Mayo Clinic
Microscopic Colitis Darrell S. Pardi, MD Inflammatory Bowel Disease Clinic Mayo Clinic Research Disclosure Astra Zeneca, P&G, Salix* Consulting Salix* *This program is supported by Salix. Neither Mayo
Approaches to Inflammatory Bowel Disease
2:15 3pm Best Approach to Inflammatory Bowel Disease SPEAKER Maria Abreu, MD Presenter Disclosure Information The following relationships exist related to this presentation: Maria Abreu, MD, receives consulting
OUNCE OF PREVENTION WORTH A POUND OF CURE
Healthcare maintenance in the patient with Inflammatory Bowel Disease. OUNCE OF PREVENTION WORTH A POUND OF CURE Your gastroenterologist is NOT your primary care physician Your gastroenterologist is NOT
Immunogenicity of Biologic Agents and How to Prevent Sensitization
Immunogenicity of Biologic Agents and How to Prevent Sensitization William J. Sandborn, MD Professor and Chief, Division of Gastroenterology Director, UCSD IBD Center La Jolla, California, USA Learning
Pediatric PSC A children s tale
Pediatric PSC A children s tale September 8 th PSC Partners seeking a cure Tamir Miloh Assistant Professor Pediatric Hepatology Mount Sinai Hospital, NY Incidence Primary Sclerosing Cholangitis (PSC) ;