Medical Case Views Aligning Biologic Therapy With Disease Severity in Inflammatory Bowel Disease.

Patient management of Crohn's disease and ulcerative colitis remains a challenge since current treatment options only alleviate inflammation and reduce symptoms; they do not provide a cure or prevent long-term complications. However, effective management is possible and depends on establishing an accurate diagnosis and the ability to distinguish these diseases from one another, the exclusion of other disease entities, and matching treatment options with patient types. Regardless of the patient diagnosis, the goals of therapy are to achieve induction and maintain remission of the disease. Therefore it is necessary for the clinician to match disease severity with the appropriate treatment.

While the historical approach to therapy for these diseases has been to start slow and step-up therapy as needed, a new treatment paradigm has been offered that proposes an aggressive approach to therapy with biologics, depending on the patient’s disease severity at the time of diagnosis. The purpose of this aggressive approach is to establish induction and remission quickly, thereby preventing further disease progression and long-term complications. While all patients are not candidates for this aggressive approach, it provides an option for clinicians who want to utilize biologic therapy in cases of moderate to severe disease. With the approval of a number of biologics for the treatment of Crohn’s disease in the last year, understanding the patient types who would benefit from aggressive therapy and matching the patient to the appropriate treatment has become more complicated.

Following completion of this activity, participants should be able to:

• Cite methods for establishing a differential diagnosis and disease severity in patients with Crohn's disease and ulcerative colitis
• Identify specific patient-types, based on the patient cases presented, that will benefit from a more effective approach to therapy with biologics
• Describe clinical scenarios for which it is appropriate to initiate therapy with biologics and the use of this approach in establishing induction and maintaining remission

This educational activity is designed for gastroenterologists and other clinicians interested in or involved with the treatment of patients with Crohn's disease and ulcerative colitis.

Temple University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.

Temple University School of Medicine is an approved provider of continuing nursing education by the PA State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.

Temple University School of Medicine designates this educational activity for a maximum of 1.5 AMA Physician's Recognition Award Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Temple University School of Medicine designates this education activity for a maximum of 1.5 Nursing Contact Hours.

It is the policy of Temple University School of Medicine, The Albert J. Finestone, MD, Office for Continuing Medical Education, to ensure balance, independence, objectivity, and scientific rigor in all of its sponsored or jointly sponsored educational programs. All faculty participating in programs sponsored or jointly sponsored by Temple University School of Medicine are expected to disclose to the program audience any real or apparent conflict(s) of interest related to the content of their presentation(s).

The information presented at this CME program represents the views and opinions of the individual presenters, and does not constitute the opinion, endorsement of, or promotion by, Temple University School of Medicine, Temple University Health System, or its affiliates. Reasonable efforts have been taken intending for educational subject matter to be presented in a balanced, unbiased fashion and in compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.

David T. Rubin, MD has received grant/research support from Procter & Gamble Pharmaceuticals; Salix Pharmaceuticals, Inc.; Prometheus Laboratories Inc.; and Given Imaging Ltd. He has been a consultant for Procter & Gamble Pharmaceuticals; Salix Pharmaceuticals, Inc.; Prometheus Laboratories Inc.; Abbott Immunology; UCB Pharma, Inc.; Given Imaging Ltd; Shire Pharmaceuticals; and Axcan Pharma. He is a member of the speaker’s bureau for Proctor & Gamble Pharmaceuticals; Salix Pharmaceuticals; Prometheus Pharmaceuticals; Abbott Immunology; Shire Pharmaceuticals; and Centocor, Inc.

Marla Dubinsky, MD has received grant/research support from Centocor, Inc.; UCB Pharma; Abbott Laboratories; and Prometheus Pharmaceuticals

Gary R. Lichtenstein, MD, FACG has been a consultant for Abbott Laboratories; AstraZeneca Pharmaceuticals; Axcan Pharma; Centocor, Inc.; Elan Pharmaceuticals Inc.; Procter & Gamble Pharmaceuticals; Protein Design Labs, Inc.; Salix Pharmaceuticals; Schering-Plough Healthcare Products; Serono Inc.; Shire Pharmaceuticals; GlaxoSmithKline; Synta Pharmaceuticals Corp.; UCB Pharma; and Wyeth Pharmaceuticals. He has received grants/research support from Abbott Laboratories; Centocor, Inc.; Millennium Pharmaceuticals, Inc.; Otsuka America Pharmaceutical, Inc.; Protein Design Labs, Inc.; Salix Pharmaceuticals; Schering-Plough Corp.; and Shire Pharmaceuticals, Inc. He is a member of the speaker’s bureau for Abbott Laboratories; AstraZeneca Pharmaceuticals; Centocor, Inc.; Procter & Gamble Pharmaceuticals; Salix Pharmaceuticals; and Shire Pharmaceuticals.

Russell D. Cohen, MD has been a consultant for Abbott Laboratories; Alaven Pharmaceuticals; Axcan-Scandipharm Inc.; Elan Pharmaceuticals, Inc.; Isis Pharmaceuticals, Inc.; NPS Pharmaceuticals Inc.; PDL BioPharma; Salix Pharmaceuticals; Shire Pharmaceuticals, StoneBridge Pharma, LLC; and UCB Pharma. He is a member of the speaker’s bureau for Abbott Laboratories, AstraZeneca Pharmaceuticals, Axcan-Scandipharm, Inc., Proctor & Gamble Pharmaceuticals, Prometheus Laboratories, Salix Pharmaceuticals, Schering-Plough Corp., Shire Pharmaceuticals, Tanabe Seiyaku Co., Ltd., and UCB Pharma