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Gut Feeling: A Comprehensive Look at the Pathogenesis, Management & Treatment of Inflammatory Bowel Disease

Jason Liebowitz, MD, FACR  |  Issue: June 2021  |  May 24, 2021

He provided data on this observation for infliximab, adalimumab, certolizumab and vedolizumab. To date, trough levels have been used predominantly for reactive assessments after loss of response to a biologic medication.

An ongoing debate concerns whether proactive drug monitoring is cost effective and improves outcomes for patients, and if such monitoring should be incorporated into routine clinical practice. Several factors, such as the formation of anti-drug antibodies, concomitant use of other immunosuppressants, baseline level of TNF- α in the serum of patients, hypoalbuminemia and body mass index, can affect the pharmacokinetics of monoclonal antibodies. Dr. Rubin said all these factors should be considered when evaluating efficacy and the potential for loss of electiveness of biologics in treating patients with IBD.

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Dr. Rubin ended his talk by imploring the audience to be cognizant of warning signs of IBD, such as changes in bowel habits, blood in the stool, nocturnal symptoms and unintentional weight loss. Additionally, anemia and low levels of vitamin B12, vitamin D and albumin may all be indicators of IBD.

Only through astute, thorough clinical evaluation and by working together to identify and treat IBD and its myriad manifestations will rheumatologists and gastroenterologists be able to help patients.

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Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.

References

  1. Kaplan GG, Ng SC. Understanding and preventing the global increase of inflammatory bowel disease. Gastroenterology. 2017 Feb;152(2):313–321.e2. Erratum: Gastroenterology. 2017 Jun;152(8):2084. PMID: 27793607.
  2. Fragoulis GE, Liava C, Daoussis D, et al. Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment. World J Gastroenterol. 2019 May 14;25(18):2162–2176.
  3. Fauny M, D’Amico F, Bonovas S, et al. Faecal calprotectin for the diagnosis of bowel inflammation in patients with rheumatological diseases: A systematic review. J Crohns Colitis. 2020 Jun 19;14(5):688–693.
  4. Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine or combination therapy for Crohn’s disease. N Engl J Med. 2010 Apr 15;362(15):1383–1395.
  5. Panaccione R, Ghosh S, Middleton S, et al. Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis. Gastroenterology. 2014 Feb;146(2):392–400.e3.
  6. Feagan BG, Sandborn WJ, Colombel JF, et al. Incidence of arthritis/arthralgia in inflammatory bowel disease with long-term vedolizumab treatment: Post hoc analyses of the GEMINI trials. J Crohns Colitis. 2019 Jan 1;13(1):50–57.

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Filed under:ConditionsMeeting Reports Tagged with:ACR State-of-the-Art Clinical SymposiumIBDinflammatory bowel disease (IBD)

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