Interactive Publication Overview:
The Crohn’s Disease-Ulcerative Colitis Clinical Appraisal:
Part II - Emerging trends in clinical practice
Inflammatory bowel diseases (IBD) are complex and chronic conditions that include Crohn’s disease and ulcerative colitis.1 The management of IBD has changed markedly over the past two decades, the most important trends being the advent of several therapeutic anti-tumor necrosis factor-a (anti-TNF) antibodies and recently a selective anti-integrin monoclonal antibody.2 However, several areas of therapy remain questions for debate. This interactive article represents the proceedings of a live meeting where a faculty of gastroenterologists with focused research interests and extensive clinical experience in IBD reviewed the existing medical literature for the quality of evidence surrounding a number of challenging treatment statements. This resulting information provides a framework for future discussion and research.
Learning Objectives
- Assess the benefits and/or risks of using anti-TNF agents in the peri-surgical period.
- Evaluate the withdrawal of thiopurines from combination therapy with thiopurines and anti-TNF agents in patients with Crohn’s disease who have attained remission.
- Assess whether anti-TNF therapy is associated with a disease-modifying effect.
- Evaluate the use of thiopurines as monotherapy.
- Summarize the incidence of serious infections and/or malignancies with the use of combination therapy with thiopurines and anti-TNF agents.
- Discuss the role of selective a4 integrin therapy in patients with IBD.
Target Audience
Physicians and clinicians who manage ulcerative colitis or Crohn’s disease and who need an understanding of evidence-based treatments for these conditions.
Author Affiliations and Financial Disclosures
William J. Sandborn, MD,
Division of Gastroenterology and UCSD IBD Center,
University of California San Diego,
La Jolla, California, USA.
(Please address all correspondence to Dr Sandborn at wsandborn@ucsd.edu)
Dr Sandborn discloses the following financial relationships relevant to this publication:
Grants/Research Support
Abbott, Bristol-Myers Squibb, Genentech, GlaxoSmithKline, Janssen, Millennium, Novartis, Pfizer, Procter and Gamble, Shire, and UCB.
Consulting/Speaker Fees
Abbott, ActoGeniX, AGI Therapeutics, Alba Therapeutics Corp, Albireo, Alfa Wasserman, Amgen, AM-Pharma BV, Anaphore, Aptalis, Astellas, Athersys Inc, Atlantic Healthcare Ltd, BioBalance Corp, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celek, Cellerix SL, Cerimon, ChemoCentryx, CoMentis, Coronado Biosciences, Cosmo Technologies, Cytokine Pharmasciences, Eagle, Eli Lilly, EnGene Inc, EnteroMedics, Exagen Diagnostics Inc, Ferring, Flexion Therapeutics Inc, Funxional Therapeutics Ltd, Genzyme Corp, Gilead Sciences, Given Imaging, GlaxoSmithKline, Human Genome Sciences, Ironwood, Janssen, KaloBios, Lexicon, Lycera Corp, Meda, Merck Research Laboratories, Merck Serono, Millennium, Nisshin Kyorin, Novo Nordisk, NPS, Optimer, Orexigen, PDL Biopharma, Pfizer, Procter and Gamble, Prometheus Laboratories, ProtAb Ltd, Purgenesis Technologies Inc, Relypsa Inc, Roche, Salient, Salix, Santarus, Schering-Plough, Shire, Sigmoid Pharma Ltd, Sirtris, SLA Pharma UK Ltd, Takeda, Targacept, Teva, Therakos, Tillotts Pharma AG, TxCell SA, UCB, Viamet, Vascular Biogenics Ltd, Warner Chilcott UK Ltd, and Wyeth.
Jean-Frédéric Colombel, MD
Icahn School of Medicine at Mount Sinai, Feinstein IBD Clinical Center, New York, New York, USA
Prof. Colombel discloses the following financial relationships relevant to this publication:
Grants/Research Support
CCFA and Mount Sinai.
Consulting/Speaker Fees
AbbVie, Amgen, Celgene, Genentech, Kyowa, Millennium, Navigant, Nestle, Neovacs, Pfizer, Shire, Takeda, Tigenix, and Vertex.
Geert D’Haens, MD
Inflammatory Bowel Disease Centre, Academic Medical Center, University of Amsterdam
Amsterdam, The Netherlands.
Prof. D’Haens discloses the following financial relationships relevant to this publication:
Grants/Research Support
Abbott Laboratories, Dr Falk Pharma, Given Imaging, Janssen Biologics, MSD, and Photopill.
Consulting/Speaker Fees
AbbVie, Abbott Laboratories, ActoGeniX, AM-Pharma, Boehringer Ingelheim GmbH, Centocor, ChemoCentryx, Cosmo Technologies, Elan, EnGene Inc, Dr Falk Pharma, Ferring, Galapagos, Giuliani SpA, Given Imaging, GlaxoSmithKline, Janssen Biologics, Merck Sharp and Dohme Corp, Millennium (Takeda), MSD, Neovacs, Novo Nordisk, Norgine, Otsuka, PDL Biopharma, Pfizer, Receptos, Salix, Setpoint, Shire, Schering-Plough, Tillotts, Tramedico Pharma, UCB, Versant, and Vifor.
Subrata Ghosh, MD, FRCPC, FRCP(E), FRCP, FCAHS
Department of Medicine, University of Calgary, Alberta Health Services Calgary zone, Calgary, Alberta, Canada.
Grants/Research Support
AbbVie, Janssen, Pentax.
Consulting/Speaker Fees
AbbVie, Aerpio, Bristol-Myers Squibb, Ferring, Janssen, Novo Nordisk, Pfizer, Receptos, Shire, and Takeda.
Remo Panaccione, MD, FRCPC
Department of Medicine, , Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
Prof. Panaccione discloses the following financial relationships relevant to this publication:
Grants/Research Support
AbbVie, Abbott, Bristol-Myers Squibb, Centocor, Elan, Ferring, Janssen, Millennium, Procter and Gamble, and Schering-Plough.
Consulting/Speaker Fees
AbbVie, Abbott, Actavis, Amgen, Aptalis, AstraZeneca, Baxter, Bristol-Myers Squibb, Celgene, Centocor, Cubist, Eisai, Elan, Ferring, Genentech, Gilead, GlaxoSmithKline, Janssen, Merck, Nestle, Pfizer, Prometheus, Salix, Schering-Plough, Shire, Takeda, UCB, and Warner Chilcott.
Julián Panés, MD, PhD
Department of Gastroenterology, Inflammatory Bowel Disease Unit. Hospital Clinic Barcelona, School of Medicine, University of Barcelona, Barcelona, Spain
Dr Panés discloses the following financial relationships relevant to this publication:
Grants/Research Support
Abbott Laboratories and MSD.
Consulting/Speaker Fees
AbbVie, Abbott Laboratories, Boehringer Ingelheim, Ferring, Galapagos, Genentech, Janssen Biologics, Merck Sharp and Dohme Corp, Millennium (Takeda), MSD, Pfizer, Prometheus, Roche, Shire, Schering-Plough, Tigenix, Tillotts, TxCell, and Vifor.
Laurent Peyrin-Biroulet, MD, PhD
Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy-Brabois, Universityof Lorraine, Vandoeuvre-lès-Nancy, France
Prof. Peyrin-Brioulet discloses the following financial relationships relevant to this publication:
Consulting/Speaker Fees
AbbVie, Amgen, Biogaran, BMS, Boerhinger-Ingelheim, Celltrion, Ferring, Genentech, HAC-Pharma, Hospira, Index Pharmaceuticals, Janssen, Lilly, Merck, Mitsubishi, Norgine, Pfizer, Pharmacosmos, Pilège, Sandoz, Takeda, Therakos, Tillots, UCB-pharma and Vifor.
Simon Travis, MD, DPhil FRCP
Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, Oxford University Hospitals, Oxford, UK
Prof. Travis discloses the following financial relationships relevant to this publication:
Grants/Research Support
AbbVie, Lilly, UCB, Vifor, and Norman Collison Foundation.
Consulting/Speaker Fees
AbbVie, Boehringer, Bristol-Myers Squibb, Celgene, Cosmo, Ferring, Giuliani SpA, GlaxoSmithKline, Ingelheim, Lilly, MSD, Neovacs, Nordisk, Norman Collison Foundation, Novartis, Novo, Pfizer, Proximagen, Receptos, Shire, Sigmoid Pharma, Takeda, Topivert, UCB, VHsquared, Vifor, and Warner Chilcott.