Achieving Remission in IBD: Looking to Novel Agents to Update Management Paradigms

Question Title

* 1. 1 year after starting steroids, approximately what proportion of UC patients become steroid-dependent or require colectomy

Up to 50%

Up to 60%

Up to 70%

Up to 80%

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* 2. A 30-year old woman with a 5-year history of ulcerative colitis; treated with anti TNFα therapy (infliximab 5 mg/kg standard loading and then maintenance every 8 weeks) has resulted in resolution of clinical symptoms since initiation of therapy 6 months ago. She now reports experiencing symptoms and stool cultures and assessment for C. difficile are negative. What is your first consideration for a patient who is losing response to anti-TNFα therapy?

Increase the dose

Shorten the dosing interval

Measure trough serum levels and anti-drug antibodies

Reassess for active inflammation

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* 3. A 45 year old man with extensive small bowel non-penetrating Crohn’s disease. He had been treated previously with azathioprine 2-3 mg/kg/d. When he lost response, adalimumab was added in standard loading (160/80 mg) and maintenance 40 mg every other week. After 1 year, he experienced complete loss of response and did not respond to empiric dose escalation to weekly dosing. He is now being considered for treatment with natalizumab. Which of the following is NOT true about this patient’s risk of progressive multifocal leukoencephalopathy (PML) on natalizumab?

The risk of PML is increased because of prior use of azathioprine

The risk is increased if the patient is seropositive against JC virus

The risk increases with treatment duration longer than 2 years

The risk is increased because the patient is male

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* 4. MAdCam-1 is the addressin to which the integrin α4β7 binds. What is MAdCAM-1?

Membrane addressin cell adhesion molecule-1

Mucosal addressin cell adhesion molecule-1

Mucosal activated cell addressin molecule-1

Membrane attached cell addressin molecule-1

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* 5. Vedolizumab exerts its effect by binding to which integrin:

alpha4beta1

alpha4beta7

MAdCAM-1

VCAM-1

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* 6. In the GEMINI I trial in ulcerative colitis, significantly more patients treated with vedolizumab had a durable clinical response, durable clinical remission, and steroid-free remission compared to patients treated with placebo; true or false?

True

False