Curbside Consults

What to do if it just isn't working: Management of anti-TNF non-responders

Program overview

A proportion of patients are primary non-responders to anti-TNF therapy. The availability of therapies with different mechanisms of action, and the ability to tailor anti-TNF therapy according to pharmacokinetics, now provides an opportunity to individualize therapy in TNF non-responders. Using a primary non-responder to anti-TNF therapy, this case consult will discuss some of the key management challenges that might be encountered with these patients. It will also focus on decision-making and factors to consider including dose optimization, switching within class and switching out of class.

Target audience

This activity has been designed to meet the educational needs of gastroenterologists and registered nurses involved in the care of patients with inflammatory bowel disease (IBD).

Release date: December 10, 2015
Expiry date: December 10, 2016

Learning objectives

After completing this activity, the participant should be better able to:

  • Define an anti-TNF primary non-responder and differentiate from secondary non-responders
  • Describe optimization of drug therapy for patients with IBD
  • Evaluate for the need to change anti-TNF therapy when IBD patients are non-responders
  • Provide appropriate care and counsel for patients and their families.

Faculty

Robin N. Ligler Dalal, MD
Gastroenterology Fellow
Vanderbilt University Medical Center
Nashville, TN

Biography

Robin Ligler Dalal is currently a gastroenterology fellow at Vanderbilt University Medical Center, Nashville, TN. Dr. Ligler graduated from the Medical College of Georgia in 2010, and completed her internal medicine residency at Vanderbilt in 2013. She served a year as a Chief Resident in internal medicine at Vanderbilt prior to starting fellowship. Dr. Ligler's clinical interest is in inflammatory bowel disease (IBD).

Close Biography

David A. Schwartz, MD, FACG, AGAF
Director, Inflammatory Bowel Disease Center
Professor of Medicine
Vanderbilt University Medical Center
Nashville, TN

Biography

Syllabus disclosure statement

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

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:

Name of Faculty or Presenter Reported Financial Relationship
Robin Ligler Dalal No relationships to disclose
David Schwartz Consulting fees: AbbVie, Janssen, Takeda, Tigenix, UCB
Grant support: AbbVie, UCB

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

The following PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, RN, BSN, and Jan Schultz, RN, MSN, CHCP, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

The following SCI planners and managers, Ian Morgan, MSc, and Elena Urso, BSc, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity or any amount during the past 12 months.

Accreditation

Physician continuing education

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 Postgraduate Institute for Medicine and Strategic Consultants International. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit designation

The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing continuing education

Credit designation

This educational activity for 0.5 contact hours is provided by Postgraduate Institute for Medicine.

Accreditation statement

Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Estimated time to complete activity: 30 minutes

Disclosure of unlabeled use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity 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 the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

How to obtain credit

There are no fees for participating and receiving CME/CE credit for this activity. To successfully earn credit, participants must complete the activity online during the valid credit period. Follow these steps to earn CME/CE credit:

  1. Read the target audience, learning objectives, and author disclosures
  2. Study the online educational content (can also be printed)
  3. Once the activity is complete, complete the online posttest, and the online evaluation.

Upon successful completion of the posttest, with a score of 75% or better, and the online Evaluation form, you will have immediate access to a certificate of attendance to print or save for your files.

If you have any questions regarding the CME/CE certification for this activity, please contact Postgraduate Institute for Medicine at: information@pimed.com or (303) 799-1930.

Media: Internet

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 or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

This activity is jointly provided by Postgraduate Institute for Medicine and
Strategic Consultants International
This activity is supported by an independent educational grant from
Takeda Pharmaceuticals International, Inc., US Region, UCB, and Prometheus
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