The Big Picture of IBD

Faculty

Stephen B. Hanauer, MD
Clifford Joseph Barborka Professor of Medicine
Northwestern Feinberg School of Medicine
Medical Director, Digestive Health Center
Chicago, Illinois

Millie D. Long MD, MPH
Associate Professor of Medicine
Director, Gastroenterology and Hepatology Fellowship Program
University of North Carolina at Chapel Hill
Division of Gastroenterology and Hepatology
Chapel Hill, North Carolina

Target Audience

The educational design of this activity addresses the needs of Clinical gastroenterologists and specialist NP/PAs involved in the treatment of patients with IBD.

Educational Objectives

Upon completion of this activity, participants will be able to:

1. Explain the current understanding of the immuno-inflammatory pathways in inflammatory bowel diseases (IBD) and the evolving role of Janus kinase/signal transducers and activators of transcription (JAK/STAT) as a therapeutic target
2. Describe the treat-to-target approach of managing IBD
3. Distinguish between clinical profiles of current and emerging targeted synthetic agents for the treatment of IBD

Statement of Need/Program Overview

The burden of IBD, of which Crohn's disease and ulcerative colitis are the primary entities, is significant and wide ranging. IBD that is not well-controlled impairs quality of life, social activities, travel and ability to work, leading to higher rates of absenteeism and permanent work disability.^1,2 The idiopathic intestinal inflammation of IBD requires life-long treatment and accounts for enormous hospitalization costs. According to data from the U.S. National Impatient Sample from 2004-2013, IBD was responsible for 97,865 hospitalizations in 2013 alone, with an annual hospitalization cost of $3.8 trillion.³ The 2015 National Health Interview Survey estimates that IBD affects 3.1 million Americans.⁴ Over the past two decades, the introduction of biologic therapies that target underlaying disease processes has dramatically changed the treatment of IBD. Current biologic therapy with tumor necrosis factor-α (TNF) inhibitors (i.e., infliximab, adalimumab, golimumab, and certolizumab pegol) and anti-integrins (i.e., matalizumab and vedolizumab) has improved the treatment of IBD flares and maintenance of clinical remission. These agends are, however, limited by lack of response and loss of response in a substantial proportion of patients, relapse and cessation of therapy, and effects such as risk for malignancy and infection.⁵ As the pathogenesis and treatment of IBD are complex and variable, there is a need to better understand the underlying pathogenic mechanisms and develop drug therapies to target these mechanisms.⁵ Orally administered, conventional drugs may improve adherence compared with parenteral administration. New drugs may prove to have better efficacy, tolerability, and cost-effectiveness, without a risk of immunogenicity. The oral JAK inhibitor, tofacitinib, was approved for use in ulcerative colitis in May 2018. Gastroenterologists can benefit from education that provides an update on the immunopathogenesis of IBD, a treat-to-target strategy of treatment, and data related to newer targeted synthetic agents.

References

1. Gunnarsson C, Chen J, Rizzo JA, Ladapo JA, Naim A, Lofland JH. The employee absenteeism costs of inflammatory bowel disease: evidence from US National Survey Data. J Occup Environ Med. 2013;55(4):393-401.
2. Moradkhani A, Beckman LJ, Tabibian JH. Health-related quality of life in inflammatory bowel disease: psychosocial, clinical, socioeconomic, and demographic predictors. J Crohns Colitis. 2013;7(6):467-473.
3. Lichtenstein G. Cost of Inpatient Care for IBD in the United States [abstract]. Am J Gastroenterol. 2016;11 (suppl 1):S310.
4. Dahlhamer JM, Zammitti EP, Ward BW, Wheaton AG, Croft JB. Prevalence of Inflammatory Bowel Disease Among Adults Aged >/=18 Years - United States, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(42):1166-1169.
5. Coskun M, Vermeire S, Nielsen OH. Novel Targeted Therapies for Inflammatory Bowel Disease. Trends Pharmacol Sci. 2017;38(2):127-142.

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications.  Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global Education Group designates this Enduring Webcast for a maximum of 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score at least 70% on the posttest and complete the program evaluation.

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Stephen B. Hanauer, MD: Consulting Fees: AbbVie, Actavis, Allergan, Amgen, Arena, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Ferring, Genentech, Gilead Sciences, Inc., GlaxoSmithKline, Hospira, Janssen Therapeutics, Eli Lilly and Company, Merck, Nestle, Novartis, Pfizer, Prometheus, Receptos, Salix Pharmaceuticals, Samsung Biocpis, Sanofi-Avantis, Seres Health, Shire, Takeda, Therakos, Tigenex, UCB Pharma, VHsquared; Contracted Research: AbbVie, Allergan, Amgen, Celgene, Genentech, GlaxoSmithKline, Janssen Therapeutics, Eli Lilly and Company, Novartis, Pfizer, Prometheus, Receptos, Sanofi-Aventis, Takeda, UCB Pharma; Data and Safety Monitoring Board: Bristol-Myers Squibb; Speaker: AbbVie, Janssen Therapeutics, Takeda

Millie D. Long MD, MPH: Consultant/Independent Contractor: Pfizer, AbbVie, Takeda, UCB, Janssen, Target PharmaSolutions; Grant/Research Support: Pfizer, Takeda; Honoraria: AbbVie, UCB

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Lindsay Borvansky: Nothing to disclose
Andrea Funk: Nothing to disclose
Liddy Knight: Nothing to disclose
Jim Kappler, PhD: Nothing to disclose
Julia Muino: Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.